Pulmonology Coding Alert

Question: When our pulmonologists attempt to put in a central line and have a problem, necessitating a surgeon, how should we bill the attempted procedure? Should I use a modifier or add the documented time to the visit?

Massachusetts Subscriber

Answer: You should report the attempted procedure with either modifier 53 (Discontinued procedure) or modifier 52 (Reduced services) depending on why the pulmonologist couldn't complete the central line placement.
 
Health threat: When the pulmonologist discontinues the central line placement due to circumstances that threaten the well-being of the patient, use modifier 53 (Discontinued procedure).

For instance, a pulmonologist attempts to place a central venous pressure line in a 65-year-old patient but has to stop because the patient has chest pain and shortness of breath. To identify that the procedure was started but discontinued because of the threat to the health and welfare of the patient, append modifier 53 to 36556 (Insertion of non-tunnelled centrally inserted central venous catheter; age 5 years or older).
 
Anatomy problem: When the pulmonologist cannot complete the procedure for other reasons, such as patient anatomy, stick with modifier 53. For example, a pulmonologist attempts to place a femoral line. He establishes the line, places the wire and easily threads it into the vein. He then threads the dilator over the wire into the vein. The wire stays in place, and the physician advances the triple-lumen catheter over the wire.
 
The first several centimeters of the catheter thread easily into the vein. But then the pulmonologist meets resistance. Because the pulmonologist performs all steps of the procedure except further threading of the triple lumen but the continuation could risk perforation of the vessel, you should code the partially completed procedure by appending modifier 53 to 36556.
 
Equipment failure: If the catheter kinks and the pulmonologist cannot thread it farther, you should instead append modifier 52 (Reduced services) to the procedure. Reason: The interruption was purely mechanical without threat to the patient's health.
 
Using either modifier will result in an insurer review prior to payment. Submit the claim manually with documentation explaining why the procedure was stopped or unsuccessful. The insurer will want to see how far the physician completed the procedure before terminating it. Do not adjust your charge. The payer will do so after the review.