Question: How do I code the exploration of the suprapubic space in an attempt to do a suprapubic cystostomy? I have billed Medicare several times using the code for suprapubic cystostomy with modifier -52 (reduced services) and modifier -22 (unusual procedural services). I have filed this claim and sent the operative report with it. The doctor stated that the procedure was terminated due to the risk involved. How would you code this?
Florida Subscriber
With modifier -52, the procedure was performed, but the extent of the procedure was reduced in some fashion at the discretion of the physician. With modifier -53 the surgery was terminated because of a life-threatening situation for the patient. You would not use -53 if the patient had not yet received anesthesia or surgical prep.
Your documentation of the procedure would include the operative note and documentation that indicated the extent of the procedure that was performed and the circumstances that caused it to be terminated.
Usually, modifier -53 is reserved for a life-threatening situation related to anesthesia. These would be extenuating circumstances beyond the surgeons control. If the surgeon ran into complications, or couldnt get the catheter in, or found something else that indicated that he shouldnt pursue the cystotomy at that time, the correct modifier would be -52.
It is not necessary to use the -22 modifier, which typically indicates that the surgical procedure was more intensive than usual. Based on your question, the service was not performed at all and, therefore, was not more intensive. Use of the modifier -22 may be causing more confusion. If you meet the criteria for the -53 modifiermeaning that the risk was life-threateningyou should refile the claim with the correct modifier or review payment with the carrier.