Question Modifer 74 - Aborted PFO Closure

tbonacci

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Hello -

I am working with a department where the patient was scheduled for a procedure and the procedure was aborted. The MD was unable to find what he was looking for. We were originally going to bill for an aborted procedure with a 74 modifier, but our coder who reviewed the documentation indicated that because the doctor did not find the defect he was intending to treat, we can’t bill for the procedure at all. We also can’t bill for the associated guidance procedure which has a mandatory device (HCPCS C1759) because the guidance procedure requires a primary procedure to be billed in conjunction with and, according to our coder, we can’t bill for that primary procedure because the MD technically didn’t find the defect he was trying to correct. It took the MD 3.5 hours in the Cath Lab to come to the conclusion the procedure needed to be aborted. He thought he saw a PFO, but it turned out not to be. He has very clear and thorough in his documentation of what he performed and in my opinion 60% of the procedure was performed. But, the coder is insisting on billing 93799 - Unlisted Cardiac Procedure.

Moderate sedation and local anesthetic was given. US guided micro puncture was used to obtain venous access. A sheath was placed in the right femoral and then a sheath was placed above the initial. Heparin was used. An ICE catheter was advanced to right atrium using fluoroscopy guidance. ICE was used to image the heart and locate the PFO and to guide closure. A PFO was not seen, but a possible track was identified with 2D ICE. Bubble study was conducted and negative, Doppler indeterminate. An attempt to cross a PFO (just not opened) was made. A multipurpose catheter was advanced over the J-wire using fluoroscopy and ICE guidance. Attempts to cross presumed PFO were made. Wires would not cross, therefore no real PFO. All further attempts were aborted.
Procedures Performed:
1. Intra-Cardiac Echocardiogram (ICE)
2. Attempted Percutaneous Transcatheter PFO Closure, but aborted as there was no PFO
Indication: Cryptogenic Stroke
Pre-procedural Diagnosis: Cryptogenic Stroke; Patent Foramen Ovale
Post-procedural Diagnosis: Cryptogenic Stroke; No Patent Foramen Ovale
Conclusion:
Attempted ICE-guided percutaneous transcatheter PFO closure, which was aborted when no PFO was found.

Is a modifier 74 justified, or should we bill the unlisted Cardiac Procedure 93799?
 

csperoni

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tbonacci

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-74 is only for the FACILITY to use.
I would bill this with -53 with the intended procedure if you are billing for the provider.
Here's an AAPC article about discontinue procedure modifiers: https://www.aapc.com/blog/42791-modifiers-52-and-53-vs-73-and-74/
And a very good article for -52 vs -53 which I struggled with until I read this: https://www.aapc.com/blog/42008-know-the-difference-between-modifiers-52-and-53/

Hope that helps!
This is for a facility. Thank you for your response!
 
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