ED Coding and Reimbursement Alert

Question: A physician attempted a lumbar puncture on a patient. During the procedure, the patient's left leg became numb and he had severe paresthesias. The doctor had to cease the procedure before cerebrospinal fluid was retrieved.     

Ohio Subscriber

Answer: The lumbar puncture should be coded 62270*-53 (Spinal puncture, lumbar, diagnostic; Discontinued procedure).
 
Modifier -53 is most commonly used in operating room cases that are discontinued "due to circumstances that threaten the well-being of the patient," but services performed in the OR are not the only ones that you can append -53 to.
 
Confusion stems from a note in the CPT definition that reads, "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." Many assume the term "operating suite" means "operating room" when, in fact, an operating suite is not necessarily an operating room.
 
Although this represents correct coding, many groups decide not to bill for unsuccessful procedures for public relations or political reasons. Of note: As facility coding and professional-side coding become more entwined, be sure to check with your hospital to make sure that the non-reporting does not harm the facility billing.