# Billing for local anesthetic/lidocaine



## Art111085 (Jun 15, 2011)

One of my physicians just came to me with a question that I want to be a 100% sure about before giving them my answer.
Basically he was scheduled to perform a trigger point injection on a patient however after administering local anesthetic the patient wished to discontinue the procedure and left.
My Dr. is asking if there is anything that he can bill for since the the local anesthetic was given. 
My first though is no, nothing can be billed because of the local being included in the surgical procedure. 
Now I am second guessing myself because what happens since the surgical procedure wasn't performed?
Any help would be greatly appreciated!
Thanks
Amber


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## dwaldman (Jun 17, 2011)

http://www.wpsmedicare.com/j5macpartb/resources/modifiers/modifier-53.shtml

Indicates the physician elected to terminate a surgical or diagnostic procedure due to the patient's well-being.

First, reviewing the defintion of modifer 53 relays that this modifier represents that a circumstance that could comprise the patient's well being if the physician would attempt to complete the procedure. Typically in Box 19 or electronic corresponding section, you would place the statement: "Documentation available upon request" This will prompt the carrier to review the following:
1. That the procedure was started
2. why the procedure was discontinued 
3.  the percentage of the procedure was performed

Furthermore, the above source states after induction of anesthesia which makes this modifier sound more for more invasive procedures that would require sedation versus a trigger point injection that could be reschedule at later date and amount resources/time involve in the attempt would not be a concern for accepting not report this encounter.

Below is more on modifier 53 from AMA perspective

Question 

Please provide the definition and illustration of Modifier 53. 

Answer 

Following is the definition and illustration ofModifier 53, Discontinued Procedure:

Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. 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. This circumstance may be reported by adding the modifier 53 to the code reported by the physician for the discontinued procedure. Note: This modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. For outpatient hospital/ambulatory surgery center (ASC) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for ASC hospital outpatient use).

Modifier 53 is used for physician reporting purposes.It is used to report circumstances when patients experience unexpected responses (eg, arrhythmia, hypotensive/ hypertensive crisis) that cause the procedure to be terminated. ASC policy requires documented narrative regarding how far the procedure had progressed at the point of termination. 

Modifier 53 differs from 52 (which describes a procedure that was reduced at the physician's discretion) in that a patient's life-threatening condition precipitates the terminated procedure.Modifier 53 is not used to report elective cancellation of procedures prior to anesthesia induction or surgical preparation in the surgical suite, including situations where cancellation is due to patient instability. 

For outpatient hospital/ASC facility reporting, refer to modifiers 73 and 74 in the list of ASC-approved modifiers.

Illustration of Modifier 53

Following anesthesia induction, the patient experiences an arrhythmia that causes the procedure to be terminated. The physician reports the code for the planned procedure with the 53 modifier appended.


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## DeeCPC (Jun 18, 2011)

You should be able to bill for the digital block 64450.  This happens in the ED on occassion and that is what we have billed out.


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## dwaldman (Jun 21, 2011)

Seems like it would be hard to compare the work involved in typical use for 64450  other peripheral branch such as sural nerve block, common peroneal nerve block, or lateral femoral cutaneous nerve block with applying local anesthetic for a trigger point injection.


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## dwaldman (Jun 21, 2011)

Additionally, by reporting 64450 for the local anesthetic the RVUs would exceed that of the actual procedure that was not performed.

64450 non facility RVUs 3.01
               facility RVUs 2.02

20552 non facility RVUs 1.54
                facility RVUs 1.08

20553 non facility RVUs 1.74
                facility RVUs 1.21


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