Cancelled ASC injection

Blackhorse

Networker
Messages
37
Location
Irvine, California
Best answers
0
The procedure is 64483 for L4/L5. Patient was given local Aesthesia. Somehow the PT became scared and decided to cancelled the injection. I plan to bill 64483 with modifier 74. The insurance is Blue Cross, not sure if they will pay for it. Also PT has a co-pay for ASC service, MD is worried the PT might be angary when he receives the bill because the injection was actually not done.

What do you think we should do?
 

skiboi

Networker
Messages
57
Location
Twin Falls, ID
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0
I would bill the service, and if the patient is that angry and not understanding the need to bill the service, I'd have the appropriate person adjust the account if it ultimately fell to patient responsibility.
 

thomas7331

True Blue
Messages
3,146
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8
That's correct, per the CMS guidelines for the use of modifiers 73 & 74, "These modifiers are used to report procedures that are discontinued by the physician due to unforeseen circumstances.... The elective cancellation of a procedure should not be reported." So those modifiers wouldn't be appropriate for a case that was discontinued at the patient's request.
 

ReignRuby

Contributor
Messages
12
Location
Goshen, Indiana
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0
I was informed that if a patient leaves the Pre-Op area and goes into the Procedure/OR Room, that we are able to bill for the scheduled procedure with the appropriate modifier 73 or 74. The procedure is noted as Partially Performed/Billable for an ASC. The only time a case is considered cancelled, is if the patient never entered the facility. I do not have any documentation to support this. Thoughts?
 

thomas7331

True Blue
Messages
3,146
Best answers
8
I was informed that if a patient leaves the Pre-Op area and goes into the Procedure/OR Room, that we are able to bill for the scheduled procedure with the appropriate modifier 73 or 74. The procedure is noted as Partially Performed/Billable for an ASC. The only time a case is considered cancelled, is if the patient never entered the facility. I do not have any documentation to support this. Thoughts?
Here are the CMS published guidelines for this. Most of the local Medicare contractors and your commercial payers will probably also have published policies regarding this on their web sites.

 
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