Wiki Billing preop services when surgery cancelled

[resource]

If surgery is cancelled after the pt is admitted to the preop area, can supplies used and drugs administered be billed? Are the rules different for Medicare vs. Commercial payers on this question?

 

[medcoder9]

isn't modifier 53 used for that kind of scenario? since supplies and drugs are bundled to whatever cancelled procedure is reported.

 

[mitchellde]

isn't modifier 53 used for that kind of scenario? since supplies and drugs are bundled to whatever canceled procedure is reported.

Modifier 53 can be used but only if the patient is in the room where the procedure is to be performed when the decision to cancel is made. So if the patient never leaves the preop area then no you cannot bill the service with a 53.

 

[mitchellde]

If surgery is cancelled after the pt is admitted to the preop area, can supplies used and drugs administered be billed? Are the rules different for Medicare vs. Commercial payers on this question?

If you are billing for the physician then no since the supplies and drugs were expended by the facility. If you are the facility then you might be able to apply a facility charge dependening on what your facility assessment tool allows for a visit. If the patient never left preop then you cannot use either the 73 or 74 modifier as the patient must be in the room where the procedure is to be performed when the decision to cancel occurred, just like the physician requirement for the 53. Also waht is the reason for the cancelation?