Wiki lidocaine injected, then pt left before procedure started

[ltl226]

I have billed for a discontinued service, as the procedure was already started and needed to be stopped. This is one I am unsure about. The patient had the lidocaine injection, then realized she had another appointment and left. Has anyone see this before and how did you handling the coding? Please see below:


"After we set up for a skin biopsy and anesthetized her she notes that she had to be at another doctor's appointment and left without a biopsy being taken. She vowed that she would return for the biopsy on a different day.

Is there a charge that we should be charging her since we set up for the procedure and anesthetize her and then she canceled the procedure for the biopsy was done."

 

[thomas7331]

The payer guidelines for adding modifiers for discontinued procedures usually specify that those modifiers are not to be used for the elective cancelation of the procedure by the patient, so you really can only bill for services that were actually performed in this situation, and not for the discontinued procedure.

Since the only thing performed here was the administration of the lidocaine, which by itself isn't a therapeutic procedure if it's only done as anesthesia for another procedure, then you don't have any medical necessity to support such a service. And the patient is within their rights to choose not to undergo a treatment, even if the provider doesn't agree with the reasoning, so to try to pursue payment from the patient would likely create more problems that it would solve.

My experience with these situations is that you don't have much choice other than to make the service a no-charge. My recommendation would be to just let this one go - part of the cost of doing business.

 

[ltl226]

I was leaning in that direction as well. Thank you for taking the time to write a nice detailed answer.