Incomplete colonoscopies and procedures

kimmoore1979

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I have been having an issue with Medicare specifically denying incomplete colonoscopies and other procedures with modifier 74. Has anyone else been having this issue? If so, can someone shed some light on the issue.

Thanks,
Kim
 

mitchellde

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74 is a modifier for use by outpatient facilities. Are you billing for the physician or for the facility? Also 74 is a discontinued procedure modifier, if the procedure is partially completed the You should look at the 52 modifier.for either facility or physician
 

kimmoore1979

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I am billing for the facility and the notes says that the procedure is discontinued after anesthesia has been given most times. The procedure is started and after a certain point the procedure is stopped. I will try the 52 modifier and track it.

Thanks a lot Debra!
 
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trose45116

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Why was the procedure discontinued? was is aborted because of poor bowel prep? or something else? you might want to look at modifier 53. this is why i ask for the op note to look at it.

thanks
 

AthensCoder

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I have been having an issue with Medicare specifically denying incomplete colonoscopies and other procedures with modifier 74. Has anyone else been having this issue? If so, can someone shed some light on the issue.

Thanks,
Kim
For our Medicare contractor, Palmetto, they auto deny all claims with modifier 53 or 74 due to needing medical records to support the use of the modifier.

Hope this steers you in the right direction.:)
 
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