Tag Archives: modifier 52
Employ Modifier 53 For Discontinued Anesthesia Services
Posted on 09. May, 2010 by Editor.
Pain management specialties might make use of modifier 52 as well.
The situation is bound to happen: A patient undergoing surgery has complications, and your anesthesiologist must stop his services. Are you prepared to recognize a situation that calls for modifier 53 (Discontinued procedure) or even modifier 52 (Reduced services)? Learn the specific criteria for reporting each modifier to ensure successful coding every time.
Patient Status Often Determines 53 Use
You will use modifier 53 when a procedure ends due to a threat to the patient’s well-being or other extenuating circumstances. For example, the surgeon performs a preop assessment, but during the evaluation he detects a carotid bruit (785.9, Other symptoms involving cardiovascular system), so he delays the surgery indefinitely until a better evaluation can be made.
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Don’t Let Money Go Down the Drain Due to Modifier 52, 53 Confusion
Posted on 07. Apr, 2010 by Editor.
Anesthesia, patient well-being can clue you in to the best modifier choice.
When your urologist ends a procedure early, you know you need to append a modifier to the procedure code, but the challenge is deciding between modifier 52 or 53. Learn the very specific criteria for reporting each modifier to ensure successful coding every time.
Turn to 52 for ‘Physician Discretion’
You should use modifier 52 when your urologist, while performing a service or procedure, chooses to partially reduce or eliminate a portion of the code’s requirements.
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8 Simple Steps Organize Your Op Note Coding
Posted on 12. Feb, 2010 by Editor.
This aspect of op note coding is the “horse that pulls the cart.”
Stuck on how to tackle this op note or those sitting on your desk? Follow this advice, provided by Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M. and co-presenter of the “Ob-Gyn Op Notes” session at the 2009 Ob-Gyn Coding & Reimbursement Conference in Orlando.
Step 1: Itemize procedures.
Step 2: Assign CPT codes.
Step 3: Eliminate “standard” procedures.
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Can a Sleep Study Code Describe an Awake Test?
Posted on 29. Nov, 2009 by sanjay.aikat.
Question: A sleep study was ordered for a patient diagnosed with hypersomnolence. The neurologistincluded a multiple wake test in the sleep study. What CPT code should I use for the multiple wake test?
Answer: You should use 95805 (Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness). Code 95805 is the only sleep study code (95803-95811) that mentionswakefulness testing. Check if you need a modifier on 95805.
Sleep services codes (95805-95811) include recording, interpretation, and report. For cases when the neurologist does only the interpretation, use modifier 26 (Professional component) on the sleep study code.
All sleep studies must have a minimum of six hours. If the sleep study does not last that long, append modifier 52 (Reduced services) to your code.
The multiple wake test measures the patient’s ability to stay awake during a time when she is normally awake. During the wakefulness test the physician or technologist records the time it takes the patient to fall asleep during a course of four to five 20-minute nap opportunities provided during the testing period in the sleep lab.
The patient does not need to be asleep during the tests.
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52214 Coding Challenge: Fulguration, Then TUIBNC
Posted on 13. Sep, 2009 by Editor.
Question: If my physician went to do a TUIBNC and found bleeding of prostatic varices, fulgurated them, then did the TUIBNC, can I charge the 52214 for the fulguration of the prostatic varices?
Answer: Yes. You can report both the transurethral incision of the bladder neck contracture (TUIBNC) and the fulguration of the bleeding varices your urologist discovered.
First, report 52450 (Transurethral incision of prostate) for the TUIBN. Append modifier 52 (Reduced services) to show that the incision was only at the bladder neck and not the complete prostatic urethra, bladder neck to the verumontanum.
Then, you can also report 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) for the fulguration. Append modifier 51 (Multiple procedures) to indicate that your urologist performed more than one procedure during the operative session.
Skip 51 sometimes: Many payers, including Medicare, no longer require modifier 51. Processing claims electronically allows the payer to recognize when your physician performs multiple procedures and automatically make the necessary reduction in payment. Use ICD-9 diagnosis code 596.0 (Bladder neck obstruction) for the bladder neck contraction and 456.8 (Varicose veins of other sites; varices of other sites) for the prostatic varices.
Get urinary catheter coding training from urology coding guru Dr. Michael Ferragamo.
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IUD Insertion a No-Go: Which Modifier Do I Use?
Posted on 10. Sep, 2009 by Editor.
Question: My ob-gyn tried to place an IUD, but the patient had a stenotic cervix. The physician could not place the device. What modifier should I use?
Answer: The answer depends on whose advice your payer follows.
According to the American Academy of Obstetricians and Gynecologists (ACOG), you should report 58300 (Insertion of intrauterine device [IUD]) and attach modifier 53 (Discontinued service). The ob-gyn started but discontinued the service, and your practice should be able to receive partial payment for this work.
Opponents of this method point out that CPT’s definition of modifier 53 states, “due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued.” CPT’s definition indicates that the physician must also have performed the surgical prep and anesthesia induction prior to discontinuing the procedure. Note that not every patient requires a local anesthetic for the IUD insertion. Also, CPT Assistant December 1996 explains you should use modifier 53 when a patient experiences an unexpected response or life-threatening condition that causes the procedure to be terminated (such as the patient fainting or developing an arrhythmia). In other words, you shouldn’t append modifier 53 to report elective cancellation.
So what’s your alternative? Suppose your ob-gyn had applied a local anesthetic to the cervix prior to the insertion. If the ob-gyn could not place the IUD because the patient has a stenotic cervix, you should consider this a failed procedure. Therefore, experts say you should use modifier 52 (Reduced services).
Click here to see the agenda for the Ob-Gyn Specialty Coding & Billing Conference in Orlando.
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Bundle of His Recording Coding Challenge
Posted on 13. Jul, 2009 by Editor.
Question: How should I report right atrial pacing and recording when performed with bundle of His recording? May I report 93619 or should I append modifier 52?
Answer: When the cardiologist performs right atrial pacing and recording as well as bundle of His recording, but does not perform the other services described in 93619 (Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia), you should not report 93619.
You also should not report 93619-52 (Reduced services) because you have a more appropriate coding option:
• 93600 — Bundle of His recording
• 93602 — Intra-atrial recording
• 93610 — Intra-atrial pacing.
You should report these three individual codes because the cardiologist did not perform and document the other services listed in 93619’s descriptor.
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Where Anesthesia Coders Go Wrong With CS Cath Placement
Posted on 16. Jun, 2009 by Editor.
Your doc needs to do this to get paid on more than CS cath placement.
Quick — look up the CPT code for coronary sinus (CS) catheter placement used during cardiac surgery. No luck? Then an unlisted code reporting is in your future. Coding News is here to bust 3 myths that may fool you into selecting the wrong anesthesia code for this procedure:
Myth 1: Code 93508 Applies to CS Cath
Fact: Code 93508 (Catheter placement in coronary artery[s], arterial coronary conduit[s], and/or venous coronary bypass graft[s] for coronary angiography without concomitant left heart catheterization) does not apply to coronary sinus catheter placement, even if you append modifier 52 (Reduced services). In addition, the 936xx range of codes (those for EP studies) are inappropriate. Instead, an unlisted code is your best choice.
Anesthesiologists insert coronary sinus catheters for minimally invasive heart valve surgery, says Farhan Sheikh, MD, professor of anesthesiology and director of cardiac anesthesia at Albany Medical Center. “The coronary sinus is inserted with a catheter to deliver retrograde cardioplegia solution with TEE guidance, not for monitoring or angiography purposes.”
Coronary sinus pressure is monitored when the retrograde cardioplegia solution is being injected into it, but not for any other reason. Although many centers still perform the procedure, there are now less invasive means to accomplish the same patient safety goals.
Myth 2: Cath Intro Is Way to Go
An ASA teleconference in Nov. of 2008 recommended 36013 (Introduction of catheter, right heart or main pulmonary artery) for this CS cath placement. Joanne Mehmert, CPC, an independent consultant from Kansas City, Mo., disagrees, saying that currently, no…
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Capsule Endoscopy Gone Awry: 91110-What?
Posted on 01. Jun, 2009 by Editor.
Question: Our patient came in for a capsule endoscopy, but the capsule got stuck in food on hour five and visuals could not be seen past the stomach. We’ll have to repeat this to see if we can see the small and large intestine. How should we code this procedure?
Answer: If your physician is going to repeat the procedure, append modifier 53 (Discontinued procedure) to 91110 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus through ileum, with physician interpretation and report).
Another option: If you weren’t going to repeat the procedure, you could append modifier 52 (Reduced services) to reflect that the capsule imaged the patient’s anatomy until it became lodged in the food.
Whose equipment? For 91110, make sure your place of service is where the capsule’s data was downloaded. If your practice owns the equipment and capsule (and not a facility), check that your place of service was the office (POS code 11).
If a facility provided the capsule, then append modifier 26 (Professional component) to 91110 — you can code only for the professional component of the service. The facility will also code 91110 and append modifier TC (Technical component).
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Incomplete Screening Colonoscopy: Modifier 52 or 53?
Posted on 31. Mar, 2009 by Editor.
The answer depends on your payer, writes Jenny Berkshire in the April edition of the AAPC’s Coding Edge.
Sometimes screening colonscopies are attempted, but not completed–usually because the patient has been poorly prepped.
When billing Medicare, use Modifier 53 (Discontinued procedure). For private payers following CPT guidelines, use Modifier 52 (Reduced services), Berkshire recommends.
AUDIO: Why the OIG has colonoscopies on its 2009 Workplan – and what this means for you, with Jill Young.
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