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Discontinued Procedure

  1. #11
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    Columbia, MO
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    Medical Coding Books
    I got the impression the aspiration was performed, if not accomplished then go for the discontinued as Mary states. Sometimes when going thru these threads you can lose track of the original statement. So was the aspiration completed? BUt you may not bill for both the completed and the acomplished procedure at the same time either ASC or hospital outpatient, unless this is a new ruling within the last year or so.

  2. #12
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    The aspiration was completed, I know this by talking to the doctors involved. The note also stated that it was decompressed - is that the same thing as aspiration?

    My problem with the second procedure is that it was not scheduled, and it is not a covered procedure for this insurance for ASC. They would not have done this here, if they knew upfront. Was this not incidental?

  3. #13
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    I've been trying to locate something that states that you can only report one or the other and not both as Deb had indicated, but I come up empty handed. Its the first time I had ever heard it.

    Deb, can you post your resource on this? I know you mentioned the Federal Register but I couldn't find anything that stated this in the Federal Register.

    I have lots of stuff from CMS that just states the guidelines for reporting with the -74 modifier as well as many other resources which state the same, but none of them state that you can not bill a performed procedure with a terminated procedure.

    I have a couple of ASC books at home that I will check as well to see if they have anything in them.

    In your case Martn, I think you billed correctly (unless we can find the resource that states not too).

    Because the resources of the facility are consumed in essentially the same manner to the same extent as they would have been had the procedure been completed. If this modifier is not used and the patient has to come back for the same procedure, then the subsequent procedure will be denied. If you were to choose not to bill it, I would still put it in your system as a "zero" charge for documentation/audit purposes.

    As far as the aspiration goes, I would make sure that all the info you have obtained from your doc verbally is documented.

    Mary, CPC, COSC

  4. #14
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    Columbia, MO
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    Mary,
    I read this several years ago when I was studing for APCs in the outpatient setting and I was reading everything I could get my hands on. This was in the federal register that I read this about the 53, 73, and 74. ANd as I said there may have been a CPT assistant on the same subject. I do not have these references any longer, they were archived on my laptop about 5 laptops ago! I wil see if I can reproduce the search and find it again.

  5. #15
    Location
    North Carolina
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    http://www.cms.hhs.gov/Transmittals/...ads/R442CP.pdf

    Termination Where Multiple Procedures Planned

    When one or more of the procedures planned is completed, the completed procedures are reported as usual.

    When one or more of the procedures planned is completed, the completed procedures are reported as usual. The other(s) that were planned, and not started, are not reported. When none of the procedures that were planned are completed, and the patient has been prepared and taken to the procedure room, the first procedure that was planned, but not completed is reported with modifier -73. If the first procedure has been started (scope inserted, intubation started, incision made, etc.) and/or the patient has received anesthesia, modifier -74 is used. The other procedures are not reported.

    If the first procedure is terminated prior to the induction of anesthesia and before the patient is wheeled into the procedure room, the procedure should not be reported. The patient has to be taken to the room where the procedure is to be performed in order to
    report modifier -73 or -74.

  6. #16
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    I appreciate ALL your input and helping me on this. I am sure we all are learning here?

    Rebecca, I already looked at that pages, and I just want to make it clear that the aspiration (20612, second procedure)was not PLANNED, according to me it was more incidental than anything else. Incidental you do not need to code, right?

  7. #17
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    Quote Originally Posted by rebeccawoodward View Post
    http://www.cms.hhs.gov/Transmittals/...ads/R442CP.pdf

    Termination Where Multiple Procedures Planned

    When one or more of the procedures planned is completed, the completed procedures are reported as usual.

    When one or more of the procedures planned is completed, the completed procedures are reported as usual. The other(s) that were planned, and not started, are not reported. When none of the procedures that were planned are completed, and the patient has been prepared and taken to the procedure room, the first procedure that was planned, but not completed is reported with modifier -73. If the first procedure has been started (scope inserted, intubation started, incision made, etc.) and/or the patient has received anesthesia, modifier -74 is used. The other procedures are not reported.

    If the first procedure is terminated prior to the induction of anesthesia and before the patient is wheeled into the procedure room, the procedure should not be reported. The patient has to be taken to the room where the procedure is to be performed in order to
    report modifier -73 or -74.
    Rebecca...you are awesome!!!! Thank you so much for taking the time to dig this up for me

  8. #18
    Location
    North Carolina
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    Anytime Mary!

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