Modifier 74 usage

ercoder65

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I have a chart where an EGD was scheduled on a patient, and the staff appended a modifier 74 to the code (43235). The OP report stated that the scope was extended down to the duodenum, but due to food content, the gastric body was not well visualized. I am not real familiar with modifier 74, but to me, the EGD was complete because the scope was extended as far as what is normally described in the procedure; because the patient decided to eat in the 12 hour period prior to the surgery should not be a penalty to the surgeon even though he couldn't view the stomach walls. Should I remove the 74 from this facility charge? Any opinion is greatly appreciated.

TIA

Rich
 

mitchellde

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well I see your point but there was nothing the physician could do at this point because he could not complete his exam. I agree with the facility to use the 74 and the physician should use the 53. There will be reimbursement on both sides and when the physician reschedules the procedure you will be able to bill it again. Just remember you need a V64.x code as a secondary dx code.
 

ciphermed

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If the physician indicated that the procedure was terminated or incomplete due to ".....", appending modifier -74 would appear to be appropriate. For the facility, use of modifier 74 renders full payment for the procedure while modifier -73 renders 50% of the payment (Medicare) for the terminated procedure. If there is a question as to whether or not the phsycian has determined that this was an incomplete study...query the physician for clarification. You wouldn't want to bill incorrectly on the 1st try and then bill the same proceudre again....

Hope this helps,
 
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