Wiki Port-a-cath coding

[bgonzalez8289]

I need help with coding for port-a-cath placement...

1. Attempt on Left w/fluroscopic guidance unsuccessful
2. Right w/fluroscopic guidance was a successful placement.

Patient was brought to the OR, placed on OR table. Patient was intubated successfully by anesthesia with no complications. Patient was prepped and draped in sterile fashion. Local anesthetic was injected in left chest. Next large bore needle was used to access left subclavian vein. Evidence of vein was seen with aspiration of dark red nonpulsatile blood. A J guidewire was place but encountered resistance on multiple attempts to advance the wire. Left sublclavian vein was aborted. Manual pressure held for 10 minutes.

Attention was then turned to the right chest, was prepped in the same manner as left. Placement of needle in right vein with aspiration of dark red nonpulsatile blood was performed. A J guidewire was place and the position was confirmed w/ fluroscopy in the superior vena cava. Needle was removed, transverse incision was made in skin. A subcutaneous pocket was made adjacent in this wound.

I would like to know how to code??

If I code:
36561 RT
36561 LT modifier 52, 53, 74???
77001-26

If patient has Humana Medicare they payer wants use of 50 modifier for bilateral services? But it was only attempted on Left and Successful on Right.
Can I just code for what was successful??

 

[krithika]

36561 RT
36561 53/74 LT
77001 26
Please use 53 for physician coding and 74 for facility coding.

If insurance denies, we need to go for appeal with medical records.

Hope this helps. Thanks.

 

[thomas7331]

I disagree with the coding of the unsuccessful procedure and use of modifiers here. CMS guidelines state that "when one or more of the procedures planned is completed, the completed procedures are reported as usual. The other(s) that were planned, and not started, are not reported." You would only report the procedures that are actually completed in this case. The modifiers for discontinued procedures are only used when no procedure was completed. The work involved in attempting the procedure at one site is inclusive to the completed procedure. If the time involved was significant and documented, you could consider a modifier 22 to compensate the physician for the additional work.