Wiki Facility billing for incomplete colonoscopy due to poor prep

[Tracy592]

For years as a Free Standing Facility when a patient is prepared for a Colonoscopy and the MD can't advance the scope due to poor prep, we've always appended Modifier 52 (discontinued service). It is our understanding the patient will return the next day with additional prep to complete the procedure. I am reading the notes in the CPT book where it talks about incomplete colonoscopy. My interpretation of 73 and 74 modifier is when the procedure is discontinued due to extenuating circumstances or those that threaten the well being of the patient. Which modifier is correct for incomplete colon due to poor prep for the FACILITY 52, 73, or 74?

I would also need documentation to support.

 

[afalcon@dhcla.com]

we use -53 and -74 if nothing was done with icd-10 code z53.8
-52 and -74 if biopsies were taken

 

[thomas7331]

The Medicare guidance on coding and payment for terminated procedures in an ASC can be found in Chapter 14 of the Claims Processing Manual, see section 40.4 - Payment for Terminated Procedures:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c14.pdf

Modifier 73: "surgical procedure is terminated due to the onset of medical complications after the patient has been prepared for surgery and taken to the operating room but before anesthesia has been induced or the procedure initiated"

Modifier 74: "a medical complication arises which causes the procedure to be terminated after anesthesia has been induced or the procedure initiated"

Modifier 52: "discontinued radiology procedures and other procedures that do not require anesthesia"

Also, see Medicare transmittal 3368: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3368cp.pdf

"When submitting a claim for the interrupted colonoscopy, professional providers are to suffix the colonoscopy code with a modifier of “–53” to indicate that the procedure was interrupted. When submitting a claim for the facility fee associated with this procedure, Ambulatory Surgical Centers (ASCs) are to suffix the colonoscopy code with modifier “–73” or “–74” as appropriate."

 

[afalcon@dhcla.com]

In my CPT book -52 states Reduced Service. It says nothing about Radiology services.

 

[thomas7331]

In my CPT book -52 states Reduced Service. It says nothing about Radiology services.

These are regulations for OPPS claims, specifically Medicare outpatient facility claims - they are not CPT guidelines.