Mary ann Posted Thu 17th of October, 2013 10:50:44 AM
Pt. presents for a 6-month followup following coiling of a right MCA aneurysm. The pt. has a history of severe peripheral vascular disease with a history of fem-fem bypass. Femoral artery access was attempted with ultrasound guidance, but was not able to get adequate access in order to establish a sheath safely. Because of concern for jeopardizing her bypass, they elected to abort the case and not proceed with further attempts at access. How would you report this procedure? Thanks
SuperCoder Answered Fri 18th of October, 2013 00:26:49 AM
You may know to refer to codes 61697-61703 when your neurosurgeon performs surgery on an intracranial aneurysm, but does your physician's documentation specify carotid circulation, vertebrobasilar circulation, or fixing the aneurysm via a neck approach?
The answer matters because CPT has very definite guidelines that not only specify circulation and access but the difference between simple and complex aneurysms. It's up to you to know these subtle differences, or you'll run the risk of miscoding your claims -- a quick road to denials or lost revenue.
Because anesthesia was administered and the surgery already begun, assign the proper procedure code (e.g., 61700, surgery of simple intracranial aneurysm, intracranial approach; carotid circulation) with modifier -53 (discontinued procedure) appended.
When submitting the claim, include a detailed explanation of how much work was completed and the reason the service was reduced. Include a record of the time spent giving pre- and postoperative care, as well as supplies used, and compare this to the time and supplies generally necessary to complete the procedure. Do not reduce your charges. Instead, allow the carrier to determine the appropriate reimbursement using the documentation provided.
Dont confuse modifier -53 with modifier -52 (reduced services). Modifier -52 indicates that a procedure or service delivered was significantly less than that described by the closest-available CPT code. For instance, if the neurosurgeon performs three of five components of a given procedure, report the procedure code with modifier -52 appended.
In some cases, insurers may prefer that an unlisted- procedure code (i.e., 64999, unlisted procedure, nervous system) be reported rather than the next closest code with modifier -52. Check with your carrier before filing the claim.
Do not use modifier -52 for terminated services except to indicate an unusual or reduced service terminated before anesthesia is given. Generally, modifier -52 is appropriate if the physician plans to provide a less-than-complete service, whereas modifier -53 is correct if the physician must unexpectedly terminate a procedure due to unusual and/or extenuating circumstances or circumstances that place the patients well-being in jeopardy (such as uncontrollable bleeding, cardiac arrest, etc.).