Neurosurgery Coding Alert
Don't Forget to Append Modifier 53 In This Case
Question: While undergoing a lumbar spinal puncture to obtain a diagnostic sample of spinal fluid, the patient developed respiratory distress and numbness in his legs. The neurosurgeon decided to discontinue the procedure because the patient’s wellbeing was threatened. Which CPT® code should we report for this procedure, and do we need to append a modifier? Ohio Subscriber Answer: You would report the spinal puncture procedure with 62270 (Spinal puncture, lumbar, diagnostic) and append modifier 53 (Discontinued procedure) to let your payer know the procedure was discontinued. “Due to extenuating circumstances or those that threaten the wellbeing of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued,” according to Appendix A in the CPT® manual. “This circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure.” Caution: Submitting modifier 53 alone does not provide the payer with enough information to know how to correctly reimburse the provider. So, make sure you submit the supporting documentation for appending modifier 53. The documentation must state that the physician actually started the procedure, why it was medically necessary for him to discontinue the procedure, and what percentage of the procedure he did perform.
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Don't Forget to Append Modifier 53 In This Case
Question: While undergoing a lumbar spinal puncture to obtain a diagnostic sample of spinal fluid, [...]
