Wiki Discontinued service before anesthesia

[CWISNER]

My doctor had a case yesterday where the pateint was ready to be administered anethesia but changed his mind and jumped off the table. He wants to still bill the insurance company for this with either a special code or modifier. I don't see how this can be billed because this wasn't discontinued due to it being life threatening, and I've never heard of any kind of code that would fit this situation. Help!

Any suggestions would be greatly appreciated! Thank you.

 

[ALONNA]

Good Morning,

If you would look in Your CPT Manual under Appendix A I will give a description of all the Asc and physician modifiers. I am thinking that you would need to use modifier 73 for cancellation or termination of a procedure due to elective reasons either by the patient or the physician. If you would read the description under modifier 53 it will explain this to you. To get proper reimbursement for this you would need to code the CPT portion of this procedure followed by applying modifier 73. Since the patient decided not to have surgery you would need to addply V64.2 for (surgery/procedure not carried out dur to patient's decision). I think if you use this you will recieve the partial reimbursement.

Alonna Owens, CPC-H
Tallahassee Memorial Healthcare(alonna.owens@tmh.org)

 

[Aprile Murphy]

modifier 53 is used for discontinued service if doctors decides to cancell use 73 followed by the v-code that way he/she can be paid for some

 

[CWISNER]

Thank you so much, when I read the description for mod.73 I interpreted it as it must be life threatening; but after reading this again I think you're right. Thank you again!

 

[RebeccaWoodward*]

With RAC hot on our heels, I'm not so sure I would bill for this. Modifier 53 indicates that the modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation. The way I read your statement was that the patient elected to cancel the procedure by jumping off the table. Also, below are some excerpts from the ASC manual.

Payment is denied when an ASC submits a claim for a procedure that is terminated either for non medical or medical reasons before the ASC has expended substantial resources. For example, payment is denied if scheduled surgery is canceled or postponed because the patient on intake complains of a cold or flu.
• Payment at 50 percent of the rate is applied if a surgical procedure is terminated due to the onset of medical complications after the patient has been prepared for surgery and taken to the operating room but before anesthesia has been induced (use modifier 73). For example, 50 percent is paid if the patient develops an allergic reaction to a drug administered by the ASC prior to surgery or if, upon injection of a retrobulbar block, the patient experiences a retrobulbar hemorrhage which prevents continuation of the procedure. Although some supplies and resources are expended, they are not consumed to the same extent had anesthesia been fully induced and the surgery completed

http://www.medicarenhic.com/providers/pubs/Ambulatory Surgery Center Billing Guide.pdf

I would be hestitant to submit this claim without checking with your local carriers view on this scenario.

 

[martnel]

I agree with Rebecca.

 

[FTessaBartels]

E/M service

I'm assuming (I know bad to assume) that there was some E/M service prior to taking patient to OR/procedure room. You could code the E/M service (for the physician, at least).

F Tessa Bartels, CPC, CEMC