Neurology & Pain Management Coding Alert

Answer: If the neurologist attempts a lumbar puncture but is unable to obtain satisfactory results, assign the proper procedure code, e.g., 62270, spinal puncture, lumbar, diagnostic, with modifier -53 (discontinued procedure) appended.
 
When submitting the claim, include a detailed explanation of how much work was completed and the reason the service was reduced. Include a record of the time spent giving pre- and postoperative care, as well as supplies used, and compare this to the time and supplies generally necessary to complete the procedure. Do not reduce your charges. Instead, allow the carrier to determine the appropriate reimbursement using the documentation provided.
 
Be careful not to confuse modifier -53 with modifier 52 (reduced services). Modifier -52 indicates only that a procedure or service delivered was less than that described by the closest-available CPT code. Do not use modifier -52 for terminated services except to indicate an unusual or reduced service terminated before anesthesia is given. As a general guideline, modifier -52 is appropriate if the physician plans to provide a less-than-complete service, whereas modifier -53 is correct if the physician must unexpectedly terminate a procedure due to unusual and/or extenuating circumstances or circumstances that place the patients well-being in jeopardy.