# Can i bill for this procedure



## suela923@aol.com (Jun 17, 2013)

Doctor attempted to do an intervention but was unable to complete, can I bill the procedure code with the modifier 74?  Dr Z's book states that this can be used after the induction of anesthia OR AFTER THE PROCEDURE HAS BEEN STARTED (e.g. incision made, catheter inserted, biopsy pass attempted).  

If the modified procedure isn't billable would it be appropriate to bill for the equipment only?  My trainer seems to remember that she was told there must be a procedure billed.

Procedure: Right leg angiogram and attempt at treating a chronic total occlusion.

Indication: Nonhealing ulceration in right foot.

Results: Patient was identified and brought to the vascular unit. The left groin was prepped and draped in usual sterile fashion. 2% lidocaine was used to infiltrate the skin over the left femoral artery. An angiographic needle, wire, and 6-French sheath were then placed. A selective catheter was utilized to negotiate the aortic bifurcation and the sheath was placed up and over the aortic bifurcation with its tip in the right femoral artery. The patient was heparinized with 6000 units of heparin. Note this was an intervention only as a prior diagnostic study was performed. Roadmapping was performed to identify the chronic total occlusion in the distal superficial femoral artery. Attempts to cross this lesion with various catheters, wires, and frontrunner device were not successful. At the completion of the case the sheath was removed and the left groin was sealed with an Exoseal closure device. Patient tolerated the procedure well and left in stable condition. Completion studies showed continued persistence of the chronic total occlusion in the distal SFA.

Thanks!!
Sue


----------



## mitchellde (Jun 17, 2013)

74 is for after anesthesia and 73 is prior to anesthesia I have never used 74 when there was no anesthesia, also these are facility only modifiers.  however why would you not consider the 52 for this procedure.


----------



## suela923@aol.com (Jun 18, 2013)

I bill for the hospital


----------



## mitchellde (Jun 18, 2013)

Ok then why not a 52, it can be used for facility billing as well.


----------



## suela923@aol.com (Jun 18, 2013)

good question...i have to get with my trainer...she told me no on the 52...thanks for your input!


----------



## suela923@aol.com (Jun 18, 2013)

*can I bill for this procedure*

the way I am understanding these modifiers is:

52 - use if procedure if partially reduced or eliminated - this procedure is done WITHOUT anesthesia

73 - use if procedure is canceled due to extenuating circumstances or those that threaten the well being of the patient PRIOR to administration of anesthesia

 74 - use if procedure is canceled due to extenuating circumstances or those that threaten the well being of the patient AFTER the administration of anesthesia

Is this correct???

Thanks again for any and all help!!
Sue


----------



## AB87 (Jun 18, 2013)

-52 because the procedure was aborted and not completed. The MD didn't treat the occlusion


----------



## Rita Bartholomew (Jul 1, 2013)

I code facility and use 73 and 74 (depending upon documentation) for terminated procedures.  This is how facilities obtain reimbursement for all the resources consumed (supplies, staff, devices, room, etc.) to prepare for procedures which requires anesthesia in a hospital OPD/ASC. Modifier 52 description doesn't address these types of specific situations.

The Coding Clinic for HCPCS has two good references with explanations of proper uses of 52, 73 and 74 and pertinent examples -- second quarter 2008, pgs 1-4 and first quarter 2012, pgs 10,11.


----------



## hwilcox07 (Jul 1, 2013)

This came from CMS:

I. SUMMARY OF CHANGES: This manual revision clarifies use of modifiers -52,
-73, and -74. These modifiers are used to report procedures that are discontinued by the
physician due to unforeseen circumstances. Modifier -52 is used to indicate partial
reduction or discontinuation of radiology procedures and other services that do not
require anesthesia. For surgeries and certain diagnostic procedures requiring anesthesia
(including colonoscopies), the hospital may receive 50 percent of the OPPS payment
amount for cases in which the procedure is discontinued after the beneficiary was
prepared for the procedure and taken to the room where the procedure was to be
performed. If the procedure is discontinued after the beneficiary has received anesthesia
or after the procedure was started (e.g., scope inserted, intubation started, incision made)
the hospital may receive the full OPPS payment amount for the discontinued procedure.
For purposes of billing for services furnished in the hospital outpatient department,
anesthesia is defined to include local, regional block(s), moderate sedation/analgesia
(“conscious sedation”), deep sedation/analgesia, and general anesthesia.
This manual revision also clarifies that discontinued radiology procedures that do not
require anesthesia may not be reported using modifiers -73 and -74.


----------



## sashka (Jul 10, 2013)

*Bill for what was done*

I'd bill for what was complete: catheterization of the contralateral CFA 36246 and G0269 for the closure device.


----------

