# Emergancy Intubation



## KatieV7 (Nov 7, 2016)

A child was in our ER with respiratory failure and the Dr. attempted to intubate twice with no success. They called in a second Dr. that attempted twice as well but still no tube placement. Can I charge for intubation? Do I code all attempts for both doctors? What modifiers do I need if so, 77, 53?

Any and all help is appreciated. Thank you!


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## danskangel313 (Nov 9, 2016)

kfoster7 said:


> A child was in our ER with respiratory failure and the Dr. attempted to intubate twice with no success. They called in a second Dr. that attempted twice as well but still no tube placement. Can I charge for intubation? Do I code all attempts for both doctors? What modifiers do I need if so, 77, 53?
> 
> Any and all help is appreciated. Thank you!



If the procedure was discontinued due to extenuating circumstances or a threat to the patient's well-being, you could bill with a 53. The documentation would have to detail the amount of work that was done as well as the reason(s) it was unsuccessful. 

If the provider elected to stop trying to intubate, then the 53 would not be appropriate. In order to bill in that instance, the provider would have had to complete the basic portion of the procedure, which it sounds like wouldn't be the case here.

The 77 mod would not be appropriate because this all basically occurred during the same encounter (session). You could try billing for the second provider the same as the first, if the procedure was discontinued as explained above, and if the documentation supports it as well. I'm not sure if this one would get paid initially, but you could always try an appeal if it denies.


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## akandrew (Apr 28, 2017)

*Discontinued vs Unsuccessful Procedures*

This is the guidance we give our ED coders:

Discontinued procedures vs. unsuccessful procedures *
*
Surgery is an operation or procedure that is performed for treatment of an injury, deformity, disease or condition, by manual or instrumental means. 
*
There are many techniques utilized for surgery, such as cutting, abrading, suturing, and laser. However, not every operation or procedure has a successful outcome. 
*
The Central Office on HCPCS has received several questions regarding whether an unsuccessful operation or procedure should be reported. In response to these questions, this article is being written to provide some direction in the coding and reporting of unsuccessful operations or procedures. 
*
When a procedure is considered to have "failed," specifically the expected result of the procedure is not achieved, the procedure is coded as performed. 
*
Although, the procedure might be described as a failed procedure, in all actuality the procedure was performed and therefore should be coded. 
*
Sometimes several unsuccessful attempts are made during the same operative episode to perform a procedure and finally the last attempt is successful. *A lumbar puncture would be an example.
*
In this instance, only one unit of a single code would be reported for the procedure successfully accomplished, regardless of the numerous attempts. 
*
The unsuccessful attempts are considered a part of the successful procedure.
**Please note, a modifier would not be attached to the procedure code for unsuccessful attempts. 
*
Discontinued procedures vs. unsuccessful procedures 
*
The term "unsuccessful procedures" is sometimes used interchangeably with "discontinued procedures." Coders should understand that there is a difference between an unsuccessful procedure and a procedure that has been discontinued. An unsuccessful procedure would be a procedure that was performed but did not achieve the desired results. 
*
A discontinued procedure means that the patient was taken to the treatment room for a planned procedure and/or the procedure was initiated, but for some specific reason the procedure was either cancelled or not completed. 
*
Similar to the unsuccessful procedure, the specific discontinued procedure would be coded, but the difference is that a modifier (i.e., 52, 53) would be appended to the code to report that the procedure or service was reduced, discontinued, or cancelled at the physician's discretion before or after the administration of anesthesia, if applicable. For additional information regarding discontinued procedures, see Coding Clinic for HCPCS, First Quarter 2007, pages 1-3. 
**Please note, modifiers 73 and 74 are not reported in the ED setting only the ASC setting.* Very rarely do we use modifier 52 or 53 on procedures in the ED.


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