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Discontinued Procedure

  1. #1
    Default Discontinued Procedure
    Medical Coding Books
    How would y'all code this? This was done in an ASC.

    I did: 26115-74 and 20612 and the insurance approved and paid, but the patient had a huge deductable and do not want to pay us. I just wanted to make sure that I understand this discontinued modifiers correct?

    ANESTHESIA: General

    NAME OF OPERATION: 1. Excision of mass, procedure aborted.
    2. Aspiration of mass, right hand

    INDICATIONS: This child has a history of an enlarging mass about the volar aspect of the right hand and is now here for the above-listed operative procedure.

    PROCEDURE: The patient was taken to the operating room. Numerous attempts were made to start an intravenous line for the procedure.

    The operative procedure was aborted, after anesthesia was administered. However, an 18 gauge needle was used to attempt to aspirate the lesion and this was noted to be a cystic mass which was decompressed.

  2. Default
    Since the aspiration was successful, I would just code the aspiration.

  3. #3
    Location
    Columbia, MO
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    Amy is correct. You may not code a discontinued procedur with a completed procedure.
    Debra Mitchell, MSPH, CPC-H

  4. #4
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    Even if teh second procedure/replacement procedure did not need aneasthesia?

  5. #5
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    That is correct a claim can contain either all completed procedures or all discontinued procedures but never both.

  6. #6
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    Is there any documentation for this? None of the info that I have says what to do if a replacement (not scheduled) procedure was done. I appreciate all your input!

  7. #7
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    Go back to the federal register where the 53 modifier is discussed. I read this several years back... also I think I recall a CPT assistant on this as well. I read this as I said many years back, I follow every rule and rule change very carefully and there has been nothing new that I have read on this so I have to assume everything I read all those years back is still current and accepted. When I say years back I am going back to around 1998 or so.

  8. #8
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    Thanks Mitchellde! I have read that, but I am still not 100% on this one. I also looked into the payment, because I was trying to figure out why I did it this way. I found out that the second or replacement procedure is not covered by the insurance in an ASC. Should I still only bill for that (20612), and get nothing, or should I bill ONLY for the first (aborted, scheduled) procedure? If they planned to do a aspiration, they would have done that in the office. I want to do what is right, not what is most money. I also feel like if we cannot bill 26615-74, the patient should not get the benefit of a deductable being taken care of, and I should then probably do a corrected billing?

  9. #9
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    I know you feel kind of backed into a corner on this, however I would bill the procedure acomplished, the aspiration.

  10. #10
    Location
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    Since you are in an ASC, yes you can bill for both the aborted procedure and the completed procedure. You did do it correctly. Anesthesia was performed for the major procedure which was aborted. Also the note that you posted does not state that the aspiration was complete...it was attempted. I would do the primary planned procedure with the 74 modifier and not code for the aspiration because it only states attempted.

    my two cents
    Mary, CPC, COSC

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