Pulmonology Coding Alert

Question: We were performing CPT 78588 (pulmonary perfusion imaging, particulate, with ventilation imaging, aerosol, one or multiple projections). The patient inhaled the aerosol, we took the initial scan, and then the doctor injected the albumin before the second scan.

But before we performed the second image, the patients heart rate sped up and we had to discontinue the procedure. Do we bill the CPT 78588 with the discontinued procedure modifier (-53) or do we just bill for a lesser perfusion imaging scan, using something like 78586 instead?

Utah Subscriber

Answer: When billing to Medicare, you should bill the 78588 with the modifier -53 appended, which most accurately reflects the scenario that has occurred the procedure was discontinued due to the patients intolerance and/or life-threatening circumstances. The claim will need to be reviewed by your carrier, so you should send a paper claim explaining the circumstances, rather than sending your claim electronically. Your reimbursement will be based upon the extent of the procedure that was completed.

An advantage to coding the procedure this way (using the discontinued procedure modifier) is that modifier -53 will justify another claim for 78588 on a later date if the pulmonologist chooses to try the procedure again another time. Non-Medicare insurers could require you to report a lesser perfusion imaging code to identify specifically what was performed. Otherwise, the non-Medicare insurers would disregard the modifier and pay you for the entire service. To be completely accurate in your coding, ask your non-Medicare carriers what code you should report for this type of service.

Answers for You Be the Coder and Reader Questions were provided by Carol Pohlig, BSN, RN, CPC, reimbursement analyst at the Hospital of the University of Pennsylvanias department of medicine in Philadelphia.