suela923@aol.com
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Hi everyone,
I am really struggling with when to apply a modifier for a discontinued procedure. In the following scenerio I thought I should apply 52 modifier but was told no, because the balloon for the angioplasty was opened, but not used. That makes sense to me but it does seem the doctor did a lot of the prep work for the angioplasty but was unable to continue. He did do the fistulagram which is billable so would I just bill that, 36147, and not the other charges of 36148, 35475-52, 75962-52? Thanks!
Procedure: Right arm fistulogram.
Indication: Poor maturation.
Results: The patient was identified and brought to the vascular unit. The right arm was prepped and draped in the usual sterile fashion. 2% lidocaine was used to infiltrate the skin over the AV fistula and a micropuncture technique was used to access the fistula. Formal fistulogram was performed with the following findings:
At the arterial anastomosis, there is a severe stenosis. The proximal, mid, and distal portions of the AV fistula are patent. The cephalic arch is patent. The central veins are all patent without stenosis. The catheter was removed and a separate puncture was performed in a retrograde direction. An attempt was made to cross the proximal anastomotic stenosis. I attempted to cross this with multiple guidewires and this was unsuccessful. At the completion of the case, the catheter was removed and pressure was held without incident.
Result Impression
Severe stenosis at the arterial anastomosis of the AV fistula. Not amenable to endovascular treatment. Recommend surgical revision of the AV fistula.
I am really struggling with when to apply a modifier for a discontinued procedure. In the following scenerio I thought I should apply 52 modifier but was told no, because the balloon for the angioplasty was opened, but not used. That makes sense to me but it does seem the doctor did a lot of the prep work for the angioplasty but was unable to continue. He did do the fistulagram which is billable so would I just bill that, 36147, and not the other charges of 36148, 35475-52, 75962-52? Thanks!
Procedure: Right arm fistulogram.
Indication: Poor maturation.
Results: The patient was identified and brought to the vascular unit. The right arm was prepped and draped in the usual sterile fashion. 2% lidocaine was used to infiltrate the skin over the AV fistula and a micropuncture technique was used to access the fistula. Formal fistulogram was performed with the following findings:
At the arterial anastomosis, there is a severe stenosis. The proximal, mid, and distal portions of the AV fistula are patent. The cephalic arch is patent. The central veins are all patent without stenosis. The catheter was removed and a separate puncture was performed in a retrograde direction. An attempt was made to cross the proximal anastomotic stenosis. I attempted to cross this with multiple guidewires and this was unsuccessful. At the completion of the case, the catheter was removed and pressure was held without incident.
Result Impression
Severe stenosis at the arterial anastomosis of the AV fistula. Not amenable to endovascular treatment. Recommend surgical revision of the AV fistula.