Question Code Intended Procedure

[jojokat]

We are having a discussion about which is the proper way to code a procedure. One side states only code how far the surgeon got in the procedure (which happens to fall onto the inpatient only code list) and the other side states to code the intended procedure with the reduced service modifier since the full procedure was reduced/cancelled. The codes in question are 36830-52 (OP) vs. 35701 (IP) and the patient procedure was performed in same day surgery at a hospital.

Thank you in advance.

 

[csperoni]

I would only bill the intended procedure with -52 if there is not a better code to describe what was performed.
For example: Physician intended to perform an open total hysterectomy with bilateral salpingo-oophorectomy (remove uterus, cervix, tubes & ovaries). However, the cervix was severely adhered to bladder. Decision was made to leave the cervix in place to avoid increased risk of bladder injury. So the physician performed a supracervical hysterectomy with bilateral salpingo-oophorectomy (remove uterus, tubes & ovaries).
I wouldn't code for a total hysterectomy with salpingo-oophorectomy with -52. 58150-52
I would code for a supracervical hysterectomy with salpingo-oophorectomy since that is what was done. 58180
If you use the logic to code the intended procedure with -52, what about situations where they open the patient, then realize disease is too extensive and close the patient only doing an exploratory laparotomy (or laparoscopy). You wouldn't code a radical debulking with -52 if you removed nothing from the patient.

FYI - depending on why the procedure was cancelled, -53 may be more appropriate than -52.

 

[OpenClaims]

I definitely agree with the above. Code the intended procedure with a 53 or 52 depending on the circumstances.