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Extended procedure time, procedure not completed.

Lois Posted Thu 01st of November, 2012 15:28:17 PM

The physician asked me to use a modifier to indicate the procedure took longer than usual. When I read the documentation he attempted to perform a femoral angioplasty and extended time was spent in the attempt, however, the attempt was unsuccessful. He introduced several catheters and wires. The superficial femoral artery was 100 percent occluded and the attempt to open the artery was unsuccessful. He did document total procedure time 2 and a half hours. Do I bill this with a modifier 22 for the extended time or a modifier 53 since the procedure was dicontinued or do I bill both?

SuperCoder Answered Thu 01st of November, 2012 20:34:51 PM

I would not bill modifier 22 for an incomplete procedure. Several physicians involved in the CPT coding and nomenclature groups concur with this advice. Their rationale is:

If you give up trying to obtain a specimen or discontinue the procedure, you should use modifier -53 (Discontinued procedure).

An incomplete procedure may require more time than a complete procedure would take. You may attempt to perform the procedure multiple times before deciding to discontinue the procedure.

But, the additional time won't bring you added reimbursement. The increased work probably doesn't justify modifier 22 (Unusual procedural services. Reimbursement is performance-oriented. Asking for additional reimbursement when you didn't perform the procedure is a hard-sell.

Jen Godreau, CPC, CPMA, CPEDC

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