Sue Posted Wed 02nd of September, 2015 18:00:25 PM
A PATIENT HAD PROCEDURE 52648 ON 12-18-15; DUE TO SUBOPTIMAL VISUALIZATION, DR HAD TO END PROCEDURE AND BROUGHT PATIENT BACK 1-22-15 TO FINISH. I CODED SECOND 52648 WITH 58. NOW THE INSURANCE CO WANTS THE MONEY BACK FOR 52648-58 SAYING EXCEEDS ONCE IN A LIFETIME MAXIMUM, SHOULD I HAVE USED 52630-58? ANY SUGGESTIONS?
SuperCoder Answered Thu 03rd of September, 2015 01:04:55 AM
For DOS: 12-18-2014, you terminated the procedure with reason, but you billed CPT 52648 without any modifier. Ideally, you should bill 52648 with -53 modifier which can indicate that the procedure had been terminated/discontinued due to some reason. But you did not billed so. And you re-performed the same procedure on same patient withing the global period of 52648 with modifier 58 and you got billed for the same as well. Kindly correct the billing pattern of 12-18-2014 as 52648-53 modifier and for 01-22-2015 as 52648-58 modifier, if possible.