lidocaine

npricercm

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I was told by a co-worker that lidocaine given topically is anesthesia and we could use a -53 modifier in the outpatient hospital setting. Has anyone ever coded that way? The patient had an aspirate and then said stop, he wanted to be under anesthesia due to the pain of a bone marrow biopsy.
 
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dwaldman

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They are probably referencing the below or similar document that is for hospital reporting that defines "anesthesia" for the purpose of discontinued procedures, but the documentation for pre payment review would have to include information such as and the claim would be subject to the payers decision if payment is warranted:

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


https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R442CP.pdf


A. Background: CMS has received questions about the use of these modifiers that indicate that clarification of our policy is needed.

Policy: This manual revision clarifies use of modifiers -52, -73 and -74. These modifiers are used to report procedures that are discontinued by the physician due to unforeseen circumstances. For billing under the OPPS, modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. For surgeries and certain diagnostic procedures requiring anesthesia (including colonoscopies), the hospital may receive 50 percent of the OPPS payment amount for cases in which the procedure is discontinued after the beneficiary was prepared for the procedure and taken to the room where the procedure was to be performed. If the procedure is discontinued after the beneficiary has received anesthesia or after the procedure was started (e.g., scope inserted, intubation started, incision made) the hospital may receive the full OPPS payment amount for the discontinued procedure. For purposes of billing for services furnished in the hospital outpatient department, anesthesia is defined to include local, regional block(s), moderate sedation/analgesia (“conscious sedation”), deep sedation/analgesia, and general anesthesia
 

npricercm

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They are probably referencing the below or similar document that is for hospital reporting that defines "anesthesia" for the purpose of discontinued procedures, but the documentation for pre payment review would have to include information such as and the claim would be subject to the payers decision if payment is warranted:

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


https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R442CP.pdf


A. Background: CMS has received questions about the use of these modifiers that indicate that clarification of our policy is needed.

Policy: This manual revision clarifies use of modifiers -52, -73 and -74. These modifiers are used to report procedures that are discontinued by the physician due to unforeseen circumstances. For billing under the OPPS, modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. For surgeries and certain diagnostic procedures requiring anesthesia (including colonoscopies), the hospital may receive 50 percent of the OPPS payment amount for cases in which the procedure is discontinued after the beneficiary was prepared for the procedure and taken to the room where the procedure was to be performed. If the procedure is discontinued after the beneficiary has received anesthesia or after the procedure was started (e.g., scope inserted, intubation started, incision made) the hospital may receive the full OPPS payment amount for the discontinued procedure. For purposes of billing for services furnished in the hospital outpatient department, anesthesia is defined to include local, regional block(s), moderate sedation/analgesia (“conscious sedation”), deep sedation/analgesia, and general anesthesia

Thanks! I work in the outpatient dept and none of this information is helpful. The documentation doesn't support the modifier.
 
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