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Aborted procedure - I code outpatient visits

  1. #1
    Default Aborted procedure - I code outpatient visits
    Medical Coding Books
    I code outpatient visits and this scenario came up the other day and I would like to see how others handle same situation.
    Patient was taken to surgery (OPS) for a discogram, the surgeon actually started the procedure, but due to patient's size the needle was not long enough, so they aborted the procedure for a later date. This then turned into an OP visit for me to code. The procedure was charged, but I was told by the In-patient coder to get the charge taken off the account. Why can't the hospital charge for this procedure with a modifier? We only modify Medicare--this patient is not Medicare, how can the hospital get paid?

  2. Default
    The needle was not driven into the patient. So, the hospital is not supposed to cahrge for this incident.

  3. #3
    Default aborted procedure
    If the patient was an outpatient (I'm assuming since you code outpatients) and the procedure was started, if the needle was actually inserted, the patient was given anesthesia, then you should be able to code and add the modifier 74. If no anesthesia was given but they were in the OP room, you can code and add the 73 modifier. If modifier 73 is used medicare will reimburse 50% and if 74 is used (pt had anesthesia) then 100% will be reimbursed.
    This is just my opinion.

  4. #4
    I agree with Anna Weaver. As long as the patient entered the operating suite, it is codeable/billable with a modifier.

  5. Default
    The patient is taken to the OR for lap chole, anesthesia is given, the trocars are placed in the abdomen, the physician is called away, so the procedure is aborted. But it completed a couple hours later on the same day, by the same physician.

    I have never had a situation like this before. does anyone have any advice? If it was simply cancelled it wouldn't be a problem, but it was actually started, stopped and then completed later.

    Please help!

  6. Default

  7. #7
    Boise, Idaho
    Since anesthesia was given the first time you can do a d/c procedure with -53 and then on the actual procedure use a -76. When anesthesia is administered but the procedure was not completed you can do a -53 or a -52. The same day might be tricky but your notes will support the services.

  8. #8
    Facility Outpatient coding for this procedure should be code the procedure with the 74 modifier if the patient actually entered the surgery suite and any med given, be sure to include V64.x

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