Coding Help

monica03

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Patient is already in a global for a distal radius fx. Was non-compliant and re-displaced the fx and had to be taken back to the OR.

OP Note: After an adequate level of anesthesia was obtained, the fracture site was manipulated under fluoroscopy, evaluated and after several attempts at manipulation, it was felt that there was just too much callus, was not going to move, and did not feel like it was appropriate to proceed with open reduction and internal fixation at this point in the healing process. Short arm cast was applied.

I am not really sure how to go about coding this. Would it be 25605,78,52? Any help is appreciated.
 

AlanPechacek

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Your procedural code 25605 is correct, and then has to be modified. Modifier 78, Unplanned Return to OR etc. is correct for both Inpatient or Outpatient/ASU use. But, rather than using Modifier 52: Reduced Services, I would recommend Modifier 53, if done as an Inpatient, or Modifier 74 for an Outpatient/ASU setting because the reason for discontinuing the procedure was inability to achieve a satisfactory reduction after several attempted manipulations, while already under anesthesia. Also, send the Operative Report as supportive documentation.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com
 

mitchellde

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The 74 modifier you suggested is for facility billing not provider. However I disagree with using a modifier for a cancelled procedure as opposed to a reduced service. The procedure was begun as the provider did document the manipulation under anesthesia, however he could tell that it was not going to be successful.
 

inc1961

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It has been my understanding that:

Modifier 52 is to be use when only a portion of a procedure is needed.
Modifier 53 used when only a portion of the procedure can be done.

I'd love further discussion or input on this?

Thank you,
 

JEYCPC

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It has been my understanding that:

Modifier 52 is to be use when only a portion of a procedure is needed.
Modifier 53 used when only a portion of the procedure can be done.

I think of it like this:

52: Lower service because of the Doc's decision to decrease the service based on their judgement. (A portion of the service not provided)
53: Extenuating circumstances or those that threaten the well being of the patient.
 

mitchellde

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53 is for a discontinued procedure that is discontinued for a variety of reasons. It may be a procedure that never was started but the patient was in the procedure room when the decision to discontinue was mad. Or it can be a procedure that may have been started but no part of the procedure was accomplished for whatever reason, such as equipment failure, or patient issue.
The 52 is a reduced service where the procedure has been started and parts of the procedure have been accomplished but the procedure could not be completed in its entirety.
 

monica03

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53 is for a discontinued procedure that is discontinued for a variety of reasons. It may be a procedure that never was started but the patient was in the procedure room when the decision to discontinue was mad. Or it can be a procedure that may have been started but no part of the procedure was accomplished for whatever reason, such as equipment failure, or patient issue.
The 52 is a reduced service where the procedure has been started and parts of the procedure have been accomplished but the procedure could not be completed in its entirety.

I ended up using the 53 modifier. I had questioned if this was right because I kept reading about life threatening problems. I ended up calling my CPC teacher and she explained it just like you are that it can be for a variety of reasons, not just life threatening ones.
 
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