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Discontinued Procedure & 50% Reduction

  1. #1
    Default Discontinued Procedure & 50% Reduction
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    Does anyone have any advice for this scenario? The doc scheduled a lap cholecystectomy w/cholangiography. He attempted the cholangiogram but was unable to continue because of a questionable blockage so he discontinued that and completed the lap chole. If I just billed the part that was completed (47562), reimbursement is 100%. If I use modifier -53 on the code that was intended (47563), then reimbursement is only 50%. Is this something that can be appealed successfully?
    Thanks for any help,
    Sue
    Sue Vermette, CPC

  2. #2
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    Quote Originally Posted by SUEV View Post
    Does anyone have any advice for this scenario? The doc scheduled a lap cholecystectomy w/cholangiography. He attempted the cholangiogram but was unable to continue because of a questionable blockage so he discontinued that and completed the lap chole. If I just billed the part that was completed (47562), reimbursement is 100%. If I use modifier -53 on the code that was intended (47563), then reimbursement is only 50%. Is this something that can be appealed successfully?
    Thanks for any help,
    Sue
    Do not think about the reimbusement. Try to bill all what was performed. If part of the procedure was performed then maybe you can use modifier 52. If not, then use 53.

  3. Default
    I would try and appeal the reduction by having your physician dictate a letter stating how much of the procedure he or she feels that they performed. If they feel that they have performed 75% of the procedure, (and describe how and why), then I would ask for 75% of reimbursement. I feel that it is more appropriate to use the 53. Modifier 53 is describing soemthing that happens during the procedure that is unexpected which is what your scenario sounds like. 52 is for something that is more planned, like if the physician knowingly has to only perform part of a procedure.

  4. #4
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    Thanks for the responses. It's always hard NOT to think about reimbursement, especially now. I appreciate the good ideas!
    Sue Vermette, CPC

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