Wiki Manometry probe insertion aborted - need advice

[pookergirl]

Need some solid advice. I have an account where the patient came into the office to have a manometry study but the RN was unable to get the probe inserted nasally because the patient couldn't tolerate it so the patient went home and didn't even see the provider. There's nothing from the provider, no note, just a quick note from the RN stating they couldn't get the probe in. However, the office charged the entire procedure, which includes the study, report and interpretation. I don't think they can charge anything, or maybe a nurse visit E/M level, but they said they were told they can (unsure by whom) as long as the equipment touched the patient. I think in this case, that's a stretch. I don't think they can even charge it with a 52 mod (which is what I would normally do if more had been done). Any advice would be appreciated. I've been sitting on this account for awhile. This is facility coding if it matters. Thanks in advance!

 

[Pam Warren]

I'm assuming you mean this is a facility charge to be billed on the UB and not a professional charge done at the facility. There's a difference. In the first example, if there's an order for the procedure to be done at the facility, and the procedure was attempted in the facility, use modifier -73 for the discontinued procedure. The service was attempted but due to patient intolerance was not continued. You are able to bill for that nurse resource use, but not the entire procedure.
If you are billing the professional service on a 1500 for a procedure performed by your doctor outside the office, then you don't have the ability to bill, since the physician is not the resource that discontinued the procedure--the work was done by the facility. Hope this helps.
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[pookergirl]

It was done at an ASC or hospital outpatient dept. It is facility coding. A 73 modifier isn't appropriate in this situation because there was no planned anesthesia. Patients are not sedated at all for this. My thinking is we can't even charge it with a reduced modifier since there are just a few lines of the RN's note that they couldn't pass it due to patient intolerance. Should they just charge an E/M level instead and reverse the charge for the manometry altogether? Again, the physician didn't see the patient. Thanks!