You Be the Coder: Unsuccessful Procedure Attempt- Published on Sun, Aug 31, 2003
Question: How should I bill for an unsuccessful procedure attempt? My internist attempted 36410 but couldn't access the vein. Should I use a modifier or some other code to signify to the insurance company that the doctor attempted the procedure but failed?
You will commonly use one of two modifiers in these situations. Modifier 52
) indicates that a physician partially reduced or eliminated part of a procedure at his or her discretion. Modifier -53 (Discontinued procedure
) identifies a procedure that the doctor terminates due to extenuating circumstances or circumstances that create risk for the patient.
In your scenario, the internist completed the procedure unsuccessfully - he didn't obtain a sample.
Consequently, you should report 36410* (Venipuncture, child over age 3 years or adult, necessitating physician's skill [separate procedure], for diagnostic or therapeutic purposes. Not to be used for routine venipuncture
). The physician completed the procedure, but without success. Therefore, you don't need to attach a modifier.
In contrast, if the internist performs only part of a procedure and the CPT code describes a larger service, you would append modifier -52 to the procedure code. For instance, your internist gives a patient 50 mg of Demerol (J2175), even though J2175 calls for 100 mg. You would append -52 to 99211 (Office visit