angiestaublin
New
It is my understanding that if a provider attempts a procedure, but it is unsuccessful, then modifier -52 should not be appended. The provider attempted the procedure and due to no fault of the provider, the procedure was unsuccessful. It is also my understanding that modifier -52 should only be used when the procedure is discontinued at the discretion of the provider or patient or the complete CPT description is not provided (i.e., unilateral and the description is bilateral). Any thoughts are appreciated. Thank you!
https://www.aapc.com/codes/coding-n...key-to-optimal-lumbar-puncture-coding-article
Unsuccessful Tap Requires No Modifier
Sometimes you can complete a spinal tap, but the results aren't want you wanted. "When you perform a lumbar puncture, your intent is to get spinal fluid," says Peter Rappo, MD, FAAP, a practicing pediatrician and clinical professor of pediatrics at Harvard Medicine School in Boston. "Anything else is not what you want."
So, how should you code if the puncture fails to produce the desired results? For instance, the needle contains blood, rather than spinal fluid. You should report 62270 without a modifier, says Diane M. Minard, CPC, pediatric coding adviser for Dartmouth Hitchcock Medical Center in Lebanon, N.H. "The pediatrician completed the procedure and obtained a specimen."
The results have no impact on the procedure or reimbursement. "Even though the outcome was flawed, you did the procedure," Rappo says. So, you deserve full payment for performing the unsuccessful procedure.
CPT® Appendix A confirms, “Under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. Under these circumstances the service provided can be identified by its usual procedure number and the addition of the modifier ‘52,’ signifying that the service is reduced.”
Put another way, modifier 52 applies when a reduction in service occurs by choice (either the provider’s or the patient’s).
https://www.aapc.com/codes/coding-n...key-to-optimal-lumbar-puncture-coding-article
Unsuccessful Tap Requires No Modifier
Sometimes you can complete a spinal tap, but the results aren't want you wanted. "When you perform a lumbar puncture, your intent is to get spinal fluid," says Peter Rappo, MD, FAAP, a practicing pediatrician and clinical professor of pediatrics at Harvard Medicine School in Boston. "Anything else is not what you want."
So, how should you code if the puncture fails to produce the desired results? For instance, the needle contains blood, rather than spinal fluid. You should report 62270 without a modifier, says Diane M. Minard, CPC, pediatric coding adviser for Dartmouth Hitchcock Medical Center in Lebanon, N.H. "The pediatrician completed the procedure and obtained a specimen."
The results have no impact on the procedure or reimbursement. "Even though the outcome was flawed, you did the procedure," Rappo says. So, you deserve full payment for performing the unsuccessful procedure.
CPT® Appendix A confirms, “Under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. Under these circumstances the service provided can be identified by its usual procedure number and the addition of the modifier ‘52,’ signifying that the service is reduced.”
Put another way, modifier 52 applies when a reduction in service occurs by choice (either the provider’s or the patient’s).
