drobinson1
Networker
Good afternoon coders,
Our radiologist attempted to do a liver biopsy on one of our inpatients but it had to be discontinued because of patient discomfort. I was thinking it would be 47000 with modifier 74 but I'm not sure. What do you think?
History: 58-year-old male with newly discovered pancreatic head mass and a right lobe of liver lesion seen on the surface in the MRI scan. The lesion was seen on post contrast MRI scan and on postcontrast CT scan.
Noncontrast CT scan of the abdomen was performed. The lesion is not visible on noncontrast CT scan. However, the location of the surface contour is comparable to the MRI scan and that was utilized as the target site. The right lateral abdomen was cleansed with Chloraprep solution. Morphine and Ativan was administered for patient discomfort and anxiety. A 19-gauge needle was advanced towards the liver. Prior to advancing through the liver capsule, the patient indicated he was unable to sustain his arm elevated position because of shoulder pain.
In view of the difficulty for the patient in maintained position for liver biopsy, the liver biopsy procedure was canceled. The 19-gauge guide needle was removed. A Band-Aid was placed. Completion CT scan showed no evidence of bleeding.
Impression:
1. Noncontrast CT scan shows isodense appearance of the liver without focal lesion.
2. Contour change at the surface of the right lobe of the liver at the site of expected liver lesion based on MRI scan was identified.
3. Due to the patient's inability to maintain arm elevated position for the procedure, despite morphine and Ativan, the biopsy procedure has been canceled. The pancreas lesion may best be biopsied with ERCP approach.
Our radiologist attempted to do a liver biopsy on one of our inpatients but it had to be discontinued because of patient discomfort. I was thinking it would be 47000 with modifier 74 but I'm not sure. What do you think?
History: 58-year-old male with newly discovered pancreatic head mass and a right lobe of liver lesion seen on the surface in the MRI scan. The lesion was seen on post contrast MRI scan and on postcontrast CT scan.
Noncontrast CT scan of the abdomen was performed. The lesion is not visible on noncontrast CT scan. However, the location of the surface contour is comparable to the MRI scan and that was utilized as the target site. The right lateral abdomen was cleansed with Chloraprep solution. Morphine and Ativan was administered for patient discomfort and anxiety. A 19-gauge needle was advanced towards the liver. Prior to advancing through the liver capsule, the patient indicated he was unable to sustain his arm elevated position because of shoulder pain.
In view of the difficulty for the patient in maintained position for liver biopsy, the liver biopsy procedure was canceled. The 19-gauge guide needle was removed. A Band-Aid was placed. Completion CT scan showed no evidence of bleeding.
Impression:
1. Noncontrast CT scan shows isodense appearance of the liver without focal lesion.
2. Contour change at the surface of the right lobe of the liver at the site of expected liver lesion based on MRI scan was identified.
3. Due to the patient's inability to maintain arm elevated position for the procedure, despite morphine and Ativan, the biopsy procedure has been canceled. The pancreas lesion may best be biopsied with ERCP approach.