Wiki 2% Lido used can I still use mod 52?

[suela923@aol.com]

The way I read Modifier 52 it states: For hospitals, this modifier is also used to indicate a cancelled radiology procedure WHICH DID NOT REQUIRE ANESTHESIA. According to CMS "For purposes of billing for services furnished in the hospital outpatient department, anesthesia is defined to include local, regional (blocks), moderate sedation/analgesia (conscious sedation), deep sedation/analgesia or general anesthesia." So my question is, do we consider the 2% Lido to be "local" and therefore anesthesia? If we do, then how can I use Mod 52 for this dicontinued procedure? Help I am very confused!! Would you bill 35476-52, 75978-52?
Thanks,
Sue

AV dialysis fistulogram using ultrasound and fluoroscopic guidance on 5/15/14.

Clinical indication: Poorly maturing right upper arm AV dialysis fistula.

Informed consent was obtained. The patient was prepped and draped in the usual sterile fashion. The skin was anesthetized with 2% Lidocaine. The patient's right upper arm fistula was not easily palpated. Therefore it was elected to use ultrasound guidance to cannulate the fistula. Under ultrasound guidance the fistula was cannulated with a micropuncture needle. Hard copy documentation of the ultrasound portion of the exam was performed.

The fistulogram shows a patent brachial artery to cephalic vein anastomosis. The cephalic vein is widely patent. There is occlusion of the right subclavian vein with multiple collaterals seen in the right shoulder region. There are several cardiac pacing wires as well as a PermCath seen in the superior vena cava.

Based on the diagnostic study it was elected to try to cross the occluded right subclavian vein. Multiple attempts were made with 5-French Berenstein, 4-French mariner, and quick cross catheters. A wire could not be advanced into the occlusion. We were unable to successfully recanalize the subclavian vein.


Result Impression


Occlusion of the right subclavian vein. The occlusion could not be crossed with a guidewire and various catheters.

 

[Jim Pawloski]

The way I read Modifier 52 it states: For hospitals, this modifier is also used to indicate a cancelled radiology procedure WHICH DID NOT REQUIRE ANESTHESIA. According to CMS "For purposes of billing for services furnished in the hospital outpatient department, anesthesia is defined to include local, regional (blocks), moderate sedation/analgesia (conscious sedation), deep sedation/analgesia or general anesthesia." So my question is, do we consider the 2% Lido to be "local" and therefore anesthesia? If we do, then how can I use Mod 52 for this dicontinued procedure? Help I am very confused!! Would you bill 35476-52, 75978-52?
Thanks,
Sue

AV dialysis fistulogram using ultrasound and fluoroscopic guidance on 5/15/14.

Clinical indication: Poorly maturing right upper arm AV dialysis fistula.

Informed consent was obtained. The patient was prepped and draped in the usual sterile fashion. The skin was anesthetized with 2% Lidocaine. The patient's right upper arm fistula was not easily palpated. Therefore it was elected to use ultrasound guidance to cannulate the fistula. Under ultrasound guidance the fistula was cannulated with a micropuncture needle. Hard copy documentation of the ultrasound portion of the exam was performed.

The fistulogram shows a patent brachial artery to cephalic vein anastomosis. The cephalic vein is widely patent. There is occlusion of the right subclavian vein with multiple collaterals seen in the right shoulder region. There are several cardiac pacing wires as well as a PermCath seen in the superior vena cava.

Based on the diagnostic study it was elected to try to cross the occluded right subclavian vein. Multiple attempts were made with 5-French Berenstein, 4-French mariner, and quick cross catheters. A wire could not be advanced into the occlusion. We were unable to successfully recanalize the subclavian vein.


Result Impression


Occlusion of the right subclavian vein. The occlusion could not be crossed with a guidewire and various catheters.

I would bill 36147 A-V shunt access which includes all imaging. No angioplasty was performed.

Thanks,
Jim Pawloski, CIRCC