Wiki Cancelled appendectomy

[jeniearle]

I have a 9 yr old patient that was going in for appendectomy. Patient was under general anesthesia, doctor did a repeat physical exam and found what she had thought was "skeletal muscle guarding", was actually in fact a pelvic/abdominal mass that arose from the pelvis to fill the pelvis and abdomen up above the umbilicus into the upper abdomen. It was quite large. Because of this newly found mass, the procedure was cancelled.

I'm wondering how this can be coded out? My initial thought was to code 44950 with modifier 53 for the professional side. But the facility side would have to use modifier 74, which indicates that an incision must be started or scope inserted...but this was never done. This was only an examination under anesthesia.

Thoughts?? Suggestions??

Thank you!

 

[nsteinhauser]

If you're coding professional fees, you would use the -53. The facility fee coder would use a -74 modifier. The -74 means the procedure was discontinued after the administration of anesthesia.....the incision doesn't have to be there yet nor does a scope have to be inserted, etc. ...the anesthesia has to have been started, that's it. Most of the commercial payers I deal with want the claim dropped to paper and a copy of the op note faxed to them when I use the -74.

Hope this helps.

 

[jeniearle]

Thank you! That is a huge help!