Reader Questions: Report Incomplete Services With Modifier

Use Modifier for Unfinished Procedures and Services

Question: A physician in our emergency department attempted two lumbar punctures, and both failed. Should I code this procedure as if it were completed, report it with a modifier, or not code it at all? If I do code it, which modifier should I use?

     Nevada Subscriber

Answer: Just because the physician couldn't complete this procedure doesn't mean you shouldn't report it, because staff members indeed performed work. But you shouldn't code an incomplete procedure as though it were completed, either. This scenario calls for a modifier, and depending on the documentation and extenuating circumstances, you should use one of the following: -52 (Reduced services), -73 (Discontinued outpatient procedure prior to anesthesia administration), or  -74 (... after anesthesia administration). So, for example, if the patient was anesthetized, you'd report 62270-74 (Spinal puncture, lumbar, diagnostic; discontinued outpatient procedure after anesthesia administration).




Don't Chop Up Hours for Continuous Infusion

Question: If a patient comes to the hospital to receive chemotherapy infusion over a 48-hour period, should we code 96410 (one unit) and 96412 (seven units) for the first 24 hours' date of service and the same thing for the next 24 hours' date of service?
    
             Arkansas Subscriber

Answer: No. Because the order is for one continuous infusion over a two-day period, you should report only one set of codes. So instead of billing one unit of 96410 (Chemotherapy administration, intravenous; infusion technique, up to one hour) and seven units of +96412 (... infusion technique, one to eight hours, each additional hour), assign 96414 (... infusion technique, initiation of prolonged infusion [more than eight hours], requiring the use of a portable or implantable pump) if the staff used a pump. For Medicare patients, report Q0084 (Chemotherapy administration by infusion technique only, per visit).

Report Circumcision and Nerve Block Separately

Question: When the physician performs a newborn circumcision, should I code for the dorsal penile block in addition to the circumcision?     

      Washington, D.C., Subscriber

Answer: In short, yes. If the physician used a clamp method, you should report the circumcision with code 54150 (Circumcision, using clamp or other device; newborn), but if she made a surgical incision, report 54160 (Circumcision, surgical excision other than clamp; newborn). Penile nerve blocks (localized anesthesia) are a separately reportable service, so you should indeed code for them in addition to the circumcision procedure. Report this method of anesthesia using 64450* (Injection, anesthetic agent; other peripheral nerve or branch). Local infiltration and topical anesthesia are included in the circumcision, though, so if the physician applied one of these for the procedure, do not code it separately.

    - Reader Questions reviewed by Sarah L. Goodman, MBA, CPC-H, CCP, president of SLG Consulting Inc. in Raleigh, N.C.