Neurology & Pain Management Coding Alert

Question: One of our neurologists scheduled a diagnostic lumbar puncture. He started the procedure but had to discontinue it because the patient developed chest pain and difficulty breathing. I submitted code 62270 for the procedure, but the payer denied the claim. Did I use the wrong code?

Delaware Subscriber

Answer: You were correct in reporting 62270 (Spinal puncture, lumbar, diagnostic), but you left out one key element by not appending modifier 53 (Discontinued procedure).

Modifier 53 is for situations when the physician sees some risk that could threaten the patient's health if the procedure continues. You can report modifier 53 with either diagnostic or therapeutic procedures. Note, however, that you can only use modifier 53 after procedure preparation took place and the procedure was actually started.

Modifier 53 is often reserved for what would be called extenuating circumstances, such as a threatening change in the patient's condition or failing equipment. When reading the operative report of a discontinued service, simply look at the reason for the discontinuance. If it indicates an extenuating circumstance occurred, use modifier 53.

Pitfall: Be careful not to confuse modifier 53 with modifier 52 (Reduced services). By contrast, you'll use 52 when your neurologist only performs part of a planned procedure, but not the entire procedure, based on his discretion not the patient's well-being.