EGD and Colonoscopy aborted procedure

bethb

Guru
Messages
111
Location
Pittsburgh Central Pennsylvania
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I am looking for suggestions for this scenario. I am on the fence as to whether we can bill the endoscopy / colonoscopy procedures with a -53 modifier or if no procedure should be billed at all.

Place of service was outpatient hospital.

The patient was given preoperative anesthesia to achieve and maintain conscious sedation. Shortly after the administration of a second dose of Versed, the patient's oxygen saturation dropped and then the patient became unresponsive. At one point her pulse was lost and she was bagged, and code was called for respiratory arrest. She responded to romazicon and Narcan and her pulse returned. She was admitted for observation.

No portions of the endoscopy or colonoscopy were done and the physician noted "respiratory arrest prior to initiation of endoscopy"

Since there was no initiation of endoscopy (or colonoscopy) our doctor is asking if the codes could be billed with -53 modifiers. The usage of the -53 modifier is murky to me for this situation. I am on the fence if the procedures could be billed with modifier -53, since the patient coded PRIOR to initiation of endoscopy.

Anyone have any thoughts or suggestions?

Thank you!
 

stephanie.moore@wdhospital.com

Guru
Local Chapter Officer
Messages
194
Location
Seabrook, New Hampshire
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Modifier 53

Good Morning,

You would not bill for the procedure as it was not started. Here is a link from one of the MAC's that has some great information on it in regards to modifier 53. http://www.wpsmedicare.com/j5macpartb/resources/modifiers/modifier-53.shtml


Supporting documentation should:
be available upon request
state the procedure was started
why the procedure was discontinued
state the percentage of the procedure was performed
 
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