Discontinued vs Unsuccessful Procedures
This is the guidance we give our ED coders:
Discontinued procedures vs. unsuccessful procedures *
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Surgery is an operation or procedure that is performed for treatment of an injury, deformity, disease or condition, by manual or instrumental means.
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There are many techniques utilized for surgery, such as cutting, abrading, suturing, and laser. However, not every operation or procedure has a successful outcome.
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The Central Office on HCPCS has received several questions regarding whether an unsuccessful operation or procedure should be reported. In response to these questions, this article is being written to provide some direction in the coding and reporting of unsuccessful operations or procedures.
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When a procedure is considered to have "failed," specifically the expected result of the procedure is not achieved, the procedure is coded as performed.
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Although, the procedure might be described as a failed procedure, in all actuality the procedure was performed and therefore should be coded.
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Sometimes several unsuccessful attempts are made during the same operative episode to perform a procedure and finally the last attempt is successful. *A lumbar puncture would be an example.
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In this instance, only one unit of a single code would be reported for the procedure successfully accomplished, regardless of the numerous attempts.
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The unsuccessful attempts are considered a part of the successful procedure.
**Please note, a modifier would not be attached to the procedure code for unsuccessful attempts.
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Discontinued procedures vs. unsuccessful procedures
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The term "unsuccessful procedures" is sometimes used interchangeably with "discontinued procedures." Coders should understand that there is a difference between an unsuccessful procedure and a procedure that has been discontinued. An unsuccessful procedure would be a procedure that was performed but did not achieve the desired results.
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A discontinued procedure means that the patient was taken to the treatment room for a planned procedure and/or the procedure was initiated, but for some specific reason the procedure was either cancelled or not completed.
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Similar to the unsuccessful procedure, the specific discontinued procedure would be coded, but the difference is that a modifier (i.e., 52, 53) would be appended to the code to report that the procedure or service was reduced, discontinued, or cancelled at the physician's discretion before or after the administration of anesthesia, if applicable. For additional information regarding discontinued procedures, see Coding Clinic for HCPCS, First Quarter 2007, pages 1-3.
**Please note, modifiers 73 and 74 are not reported in the ED setting only the ASC setting.* Very rarely do we use modifier 52 or 53 on procedures in the ED.