Wiki Struggling with discontinue procedures

[suela923@aol.com]

Hi everyone,

I am really struggling with when to apply a modifier for a discontinued procedure. In the following scenerio I thought I should apply 52 modifier but was told no, because the balloon for the angioplasty was opened, but not used. That makes sense to me but it does seem the doctor did a lot of the prep work for the angioplasty but was unable to continue. He did do the fistulagram which is billable so would I just bill that, 36147, and not the other charges of 36148, 35475-52, 75962-52? Thanks!

Procedure: Right arm fistulogram.

Indication: Poor maturation.

Results: The patient was identified and brought to the vascular unit. The right arm was prepped and draped in the usual sterile fashion. 2% lidocaine was used to infiltrate the skin over the AV fistula and a micropuncture technique was used to access the fistula. Formal fistulogram was performed with the following findings:

At the arterial anastomosis, there is a severe stenosis. The proximal, mid, and distal portions of the AV fistula are patent. The cephalic arch is patent. The central veins are all patent without stenosis. The catheter was removed and a separate puncture was performed in a retrograde direction. An attempt was made to cross the proximal anastomotic stenosis. I attempted to cross this with multiple guidewires and this was unsuccessful. At the completion of the case, the catheter was removed and pressure was held without incident.


Result Impression


Severe stenosis at the arterial anastomosis of the AV fistula. Not amenable to endovascular treatment. Recommend surgical revision of the AV fistula.

 

[jkayser]

Here is a link with pertinent info from the American Society of Diagnostic and Interventional Nephrology.

http://www.network13.org/FRM/Section_05/FF_Tools/C14-Payer_Issues/02-ASDIN_Coding_Final_2009.pdf

"11.1 FAILED PROCEDURE
What if you attempt a procedure and cannot do it? How should it be properly coded? These are important
questions. Basically, you should always code for what was actually accomplished. Beyond this, you have
three choices.
11.1.1 Code Only the Procedure Completed
One could choose to code only what was completed and omit any codes for what was attempted and not
accomplished. For example if one started out to do an angioplasty, but could not pass a guidewire and
decided to stop after the initial angiogram, you could simply code it as a cannulation and a venogram using
the 36145 and 75790 codes. This would be a reasonable choice since that is all that was actually
accomplished.
11.1.2 Modifier for Reduced Level of Service
One could use a modifier to indicate that the basic service was altered. The modifier, -52, could be used to
signify that the basic coded service has been reduced. This is designed to be used in circumstances where
a service or procedure is partially reduced or eliminated. The use of this modifier allows one to report
reduced services without disturbing the identification of the basic service. For example, if angioplasty was
attempted, but after multiple tries with several types of guiding catheters and different guidewires, you could
not get the guidewire across the lesion. In this instance the treatment could not be completed. A reasonable
choice would be to code the procedure as 35476-52 and 75978-52 to indicate a reduced level of service.
The other codes for procedures or services that were completed would be coded normally. Your report
would be individually reviewed by the intermediary to determine a payment level. This would be a
percentage of the basic fee. For this reason, documentation becomes very important to form a basis for this
determination.
11.1.3 Modifier for Discontinued Procedure
One could use a different modifier to indicate that the procedure was discontinued. This modifier is -53.
The use of this designation indicates that the procedure was started but discontinued. It could be used as
an alternative to the -52 designation in the example quoted above.
Coding tip - If you attempt an angioplasty, cannot complete it and choose to use either the -52 or -53 modifier, it is important that
you provide extra documentation to describe what you actually did do. This should be stated in terms of time and supplies. This
will enable the reviewer to determine a reimbursement level appropriately."

I hope this is helpful.

Jean Kayser CPC CIRCC