Wiki Attempted TVT revision

[desireewhite185@yahoo.com]

A doctor of ours did multiple procedures, but spent quite a bit of time, trying to find a previously done TVT/bladder sling. He could not locate it; he was going to open it up a bit/revise it. (He did not do the original TVT) How do I bill for this/for the time it took attempting to do the revision? Would I just add modifier 22 to the highest RVU I'm billing? Or add a reduced services modifier to CPT 57287? Thanks, Des

 

[EmilyMontemayor]

Without the full procedure note details it is hard to accurately code this scenario, but typically (profee coding specifically speaking) if this was attempted and unable to be performed, appending a modifier 52 for reduced procedure would be applicable for this scenario. When a procedure is considered to have ‘failed,’ specifically the expected result of the procedure is not achieved, the procedure is coded as performed. You should report the procedure with Modifier 52 and due to the fact that there was no TVT located, the service was reduced. Using modifier 52 provides a means of reporting reduced services without disturbing the identification of the basic service. Modifier 22 has specific criteria that must be met pertaining to the documentation provided by the provider for this to qualify, and just indicating that it took more time to attempt this revision would not suffice the requirement. I feel based on your details provided and coding guidelines, you could code 57287-52.

 

[csperoni]

I actually have the opposite opinion on this. He couldn't even locate the TVT/bladder sling. So he didn't attempt to revise it, he planned to revise it.
As long as the records support the additional time he spent, I personally would use -22 on primary procedure.

PS - I also think if you were going the reduced modifier route, -53 would be more appropriate than -52. https://www.aapc.com/blog/42008-know-the-difference-between-modifiers-52-and-53/