Question:

For Medicare hospital billing, if a planned PTCA is attempted but the balloon cannot be advanced across the lesion, can we bill for the attempted angioplasty?

Answer:

Facilities use modifier -74 to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated after the induction of anesthesia or after the procedure was started, due to extenuating circumstances or circumstances that threatened the patient’s well-being.

In transmittal 442 (issued January 21, 2005), the Centers for Medicare & Medicaid Services (CMS) provide the following guidelines:

  • For purposes of billing for services furnished in the hospital outpatient department, anesthesia is defined to include local, regional block(s), moderate sedation/analgesia (“conscious sedation”), deep sedation/analgesia, and general anesthesia.
  • This modifier was created so that the costs incurred by the hospital to initiate the procedure (preparation of the patient, procedure room, recovery room) could be recognized for payment even though the procedure was discontinued prior to completion.
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