Wiki What to do with this?

[Jessim929]

Hi all!

I have a dilemma. Patient was supposed to have Urolift outpatient hospital under general anesthesia. They put him under and immediately call a code on him for malignant hypothermia. Like, literally as soon as he was out. Can I bill anything in this situation? An E&M? I know the hospital can throw a -74 mod on it and bill it, but where does that leave me?

Thanks

 

[csperoni]

It seems this can be billed with -53. I have to admit, if my doc didn't even START the procedure, I would likely not bill this with -53, but rather simply with whatever E&M level is appropriate per documentation. Per the CGS Medicare website:
CPT Modifier 53: Discontinued Procedures

• Submit CPT modifier 53 with surgical codes or medical diagnostic codes when the procedure is discontinued because of extenuating circumstances.
• This modifier is used to report services or procedure when the services or procedure is discontinued after anesthesia is administered to the patient.
• Do not submit CPT modifier 53 to report an elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite.
• Do not submit CPT modifier 53 when a laparoscopic or endoscopic procedure is converted to an open procedure.

Guidelines for claim submission and documentation:

• Submit the length/amount of procedure completed and reason for discontinuing service in the electronic documentation field (or, if you are approved to submit paper claims, in Item 19).

Payment:

• Payment for discontinued procedures is based on percentage of service completed. Please note: CGS may request additional documentation for these claims.

 

[Jessim929]

We tried the -53 mod and the insurance denied it -after reviewed med recs - stating that doctor didn't complete procedure. I have a feeling that it varies insurance to insurance with these cases.

Thanks!!!