midnightsun1369
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Hello,
Pt had bronchscopy started, procedure then discontinued due to worsening hypoxia. Can I still bill this as biopsy was done prior to discontined procedure? Would I use modifier 53. Setting is outpatient hospital. Thank you for all responds.
PROCEDURE:
After informed consent of the patient, the patient had received adequate premedication anesthesia, and oxygen per nasal cannular. The Olympus BF-190 fiber bronchoscope was introduced through the left nares to the level of the vocal cords. Vocal cords were inspected and noted to move normally on phonation. In addition, the piriform sinuses, arytenoid, and epiglottis were inspected and noted to be unremarkable. There was noted to be some moderate bleeding from a nosebleed during this portion of the procedure, but the procedure was continue. Additional 2% Xylocaine was instilled over the area of the vocal cords. The scope was advanced through the vocal cords to the main carina, which appeared sharp without fullness or deviation. Additional 2% Xylocaine was instilled on the right mainstem bronchus, then over the right upper lobe bronchus where the anterior, apical, and posterior segmental bronchi inspected. The scope was
advanced down the bronchus intermedius selecting the middle lobe with the medial and lateral segmental bronchi inspected. The scope was advanced down the right lower lobe bronchus to the superior, anterior basilar, lateral basilar, posterior basilar, and medial basilar segmental bronchi inspected. The scope was then advanced into the right upper lobe bronchus where the anterior, apical, and posterior segmental bronchi were inspected. There was noted to be some nodular changes to the mucosa and the carina between these areas of the bronchi, but it was not a clear friable mass..
The scope was returned to the main carina. Additional 2% Xylocaine was instilled down the left main stem bronchus. Then, over the left upper lobe bronchus in the inferior and superior lingular, apical, posterior and anterior segmental bronchi inspected. The scope was advanced down the left lower lobe bronchus where the superior, anterior and medial basilar, lateral basilar and posterior basilar segmental bronchi inspected. No definite endobronchial lesions were noted in this area.
The scope was returned to the previously described area in the right upper lobe bronchus where ****multiple endobronchial biopsies were performed.***
However, due to persistent nasal bleeding, the scope was removed and a pediatric bite block was placed and the scope was advanced through an oral approach back to this area.
****Further biopsies were attempted; however, due to worsening hypoxemia, the procedure was discontinued.***
Samples obtained from the biopsy were sent for histological evaluation. The patient stabilized and was able to be taken to the recovery area in satisfactory condition. Findings were briefly discussed with the patient and family postprocedure. We did discuss the possibility that, depending on the results, we may need to repeat the bronchoscopy again at some time in the next few weeks for further evaluation of this area.
Pt had bronchscopy started, procedure then discontinued due to worsening hypoxia. Can I still bill this as biopsy was done prior to discontined procedure? Would I use modifier 53. Setting is outpatient hospital. Thank you for all responds.
PROCEDURE:
After informed consent of the patient, the patient had received adequate premedication anesthesia, and oxygen per nasal cannular. The Olympus BF-190 fiber bronchoscope was introduced through the left nares to the level of the vocal cords. Vocal cords were inspected and noted to move normally on phonation. In addition, the piriform sinuses, arytenoid, and epiglottis were inspected and noted to be unremarkable. There was noted to be some moderate bleeding from a nosebleed during this portion of the procedure, but the procedure was continue. Additional 2% Xylocaine was instilled over the area of the vocal cords. The scope was advanced through the vocal cords to the main carina, which appeared sharp without fullness or deviation. Additional 2% Xylocaine was instilled on the right mainstem bronchus, then over the right upper lobe bronchus where the anterior, apical, and posterior segmental bronchi inspected. The scope was
advanced down the bronchus intermedius selecting the middle lobe with the medial and lateral segmental bronchi inspected. The scope was advanced down the right lower lobe bronchus to the superior, anterior basilar, lateral basilar, posterior basilar, and medial basilar segmental bronchi inspected. The scope was then advanced into the right upper lobe bronchus where the anterior, apical, and posterior segmental bronchi were inspected. There was noted to be some nodular changes to the mucosa and the carina between these areas of the bronchi, but it was not a clear friable mass..
The scope was returned to the main carina. Additional 2% Xylocaine was instilled down the left main stem bronchus. Then, over the left upper lobe bronchus in the inferior and superior lingular, apical, posterior and anterior segmental bronchi inspected. The scope was advanced down the left lower lobe bronchus where the superior, anterior and medial basilar, lateral basilar and posterior basilar segmental bronchi inspected. No definite endobronchial lesions were noted in this area.
The scope was returned to the previously described area in the right upper lobe bronchus where ****multiple endobronchial biopsies were performed.***
However, due to persistent nasal bleeding, the scope was removed and a pediatric bite block was placed and the scope was advanced through an oral approach back to this area.
****Further biopsies were attempted; however, due to worsening hypoxemia, the procedure was discontinued.***
Samples obtained from the biopsy were sent for histological evaluation. The patient stabilized and was able to be taken to the recovery area in satisfactory condition. Findings were briefly discussed with the patient and family postprocedure. We did discuss the possibility that, depending on the results, we may need to repeat the bronchoscopy again at some time in the next few weeks for further evaluation of this area.