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Wiki attempted procedure

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alices

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Please help, one of my ER Dr.s has stated he attempted a closed reduction of a rt hip prosthesis dislocation but was unsuccessful, can I code this and put 52 on it? or should I send it back for more information because that is all he says in my ED course on the medical decision pg..thank you, alice
 
Hi Alice,

A complete procedure can be billed whether successful or not.

When a procedure is considered to have failed (expected results not achieved), the procedure is coded as performed. If the usual work of the procedure was not reduced or eliminated, I would not use modifier 52.

I know some ED providers have a policy of not billing for unsuccessful procedures that will be repeated by a specialist on the same date of service.
 
Is it documented?

Yes, you can bill a procedure that is unsuccessful - IF - Big, Red, IF it is documented.

If ALL the ED physician has written is a brief statement that he tried a closed reduction without success, then I would argue that is not enough documentation to support billing the procedure.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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