The pulmonologist inserts the bronchoscope into a sedated patient's trachea but stops when the electrocardiogram (EKG) screen shows the patient is developing a ventricular arrhythmia. An attending pulmonologist has to stop a thoracentesis because a cancer patient requires administration of a pain medication to be able to remain still enough for the pulmonologist to proceed safely with the procedure. And a resident is unable to safely complete a thoracentesis on a nervous patient, and the pulmonologist must take over the procedure.
What each of these situations has in common is that pulmonologists can lose out on fair payment for their time and effort if they do not know how to code and bill interrupted services. In addition, pulmonologists occasionally have to halt a procedure to perform cardiopulmonary resuscitation. Again, they have to know how to bill for this service in such a scenario.
Use Modifier -53
If a bronchoscopy is interrupted because the patient could not medically tolerate the procedure, the pulmonology coder would append modifier -53 (Discontinued procedure) to the CPT code for a diagnostic bronchoscopy (31622), according to Michelle Logsdon, CPC, CCS-P, coding manager for Cash Flow Solutions Inc. in Lakewood, N.J. "This indicates that the procedure was attempted but not completed," she says.
The pulmonologist would use the ICD-9 code that justifies the medical necessity for performing the procedure, such as an abnormal x-ray (793.1, Nonspecific abnormal findings on radiological and other examination of lung field), Logsdon adds. The pulmonologist could use the diagnosis indicating the reason the procedure was halted as the second diagnosis for example, specifying a ventricular arrhythmia (427.1, Ventricular tachycardia).
In another example, a patient with metastatic breast cancer (174.9) requires insertion of a chest tube to treat a spontaneous pneumothorax (512.0). The pulmonolo-gist initiates the procedure, but the patient is in too much pain to hold still and refuses to continue until her pain is under control. The pulmonologist then orders the nursing staff to start a continuous IV morphine drip. In this case, the pulmonologist could bill 32002 (Thoracentesis with insertion of tube with or without water seal [e.g., for pneumothorax] [separate procedure]), attaching modifier -53.
"Use of the -53 modifier will alert the insurer that the procedure could not be completed and was terminated at the physician's discretion because there was a problem that imposed a threat to the patient's health," says Carol Pohlig, BSN, RN, CPC, reimbursement analyst for the department of medicine at the University of Pennsylvania in Philadelphia. "If a patient is in pain and thrashing around, the pulmonologist would not want to perform the procedure even if it were minimally invasive."
The pulmonologist returns in two hours and the patient says her pain is [...]