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Billing for Cx'd procedures

  1. Default Billing for Cx'd procedures
    Medical Coding Books
    I do the billing for the physician and the ASC for pain management procedures.

    A patient came in for a procedure. A nurse took vitals and patient was brought into the ASC procedure room. It required several attempts to place an IV and the patient was placed on a cardiac monitor. The patient began having unstable tachycardia (atrial tachycardia) and her blood pressure dropped. She was given Benzodiazepine per IV. An ambulance was called and the emergency room physician was called and informed of the patient's status. The patient was transferred to the hospital and evaluated by her cardiologist.

    The facility should be able to bill with a modifier for procedure discontinued prior to the administration of anesthesia. Can anything be billed for the physician? IV and cardiac monitor are not payable codes in an ASC. This happened to two different patients in the same week and I am at a loss as what to do in this situation. The physician spent time with the patient and unfortunately, the problem did not occur until the patient was in the procedure room at the ASC.

    Thanks for your help.

  2. #2
    the ASC should bill the planned procedure code with the 73 modifier. I dont believe the surgeon is going to be able to capture any reimbursement since he had not started his procedure yet by the sounds of it. If he did, then he would be able to append the 53 modifier

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