# ESWL simulation



## drashby (Mar 11, 2013)

Hello - My doc scheduled a patient for ESWL. Upon simulation no stone found. So the procedure was not performed. Can we code fluroscopy only or is there a code for simulation or should it be 50590-52? 

Maybe I'm over thinking this -

Thanks for any help


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## Jashani1 (Mar 12, 2013)

What was done for the patient? Was the ESWL started but cancelled? Was there another procedure done? I need more info.


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## drashby (Mar 13, 2013)

I believe I have the answer - but see if you agree.  

ESWL was planned, the patient arrived and prepped (no anesthesia as of yet) "simulation on the Compact Delta II table was accomplished with obliques left and right and with biplane fluroscopy" " The patient was cooperative and we failed to see a density that would warrent EWSL and consequently the procedure was not carried out."

After discussion with the hospital they are reporting 50590-74 because they used the operating suite. I believe the only service the doc has provided is fluroscopy. He wants to bill 99222 which is inappropriate as it was scheduled as out patient. Further, 99218 is not appropriate as the documentation does not support Initial OBS. No procedure was carried out and we did not do anesthesia so I do not feel 50590 is appropriate even with the reduced modifier.

Thoughts?


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