Radiology Question for the Week of July 9, 2018

Question:

Is there a modifier that can be assigned for hospital billing in the following example? An incision was made, and anesthesia was administered for an ultrasound-guided liver biopsy. Then, the physician determined the procedure could not be performed so it was discontinued.

Answer:

The Centers for Medicare & Medicaid Services (CMS) have received numerous questions about how modifiers should be assigned for discontinued procedures when anesthesia is administered. In response to the questions, in January 2005, CMS issued transmittal 442 (http://www.cms.hhs.gov/Transmittals/downloads/R442CP.pdf), which clarifies this as follows.

If the procedure is discontinued after the beneficiary has received anesthesia or after the procedure was started (e.g., scope inserted, intubation started, incision made), the hospital may receive the full outpatient payment amount for the discontinued procedure.

For the service you describe above, report CPT^® code 47000 (biopsy of liver, needle; percutaneous). As stated in the 2018 CPT manual, if imaging guidance is performed, see 76942, 77002, 77012, 77021). Also assign modifier 74 (discontinued outpatient hospital/ambulatory surgery center procedure after administration of anesthesia).

CPT^® is a registered trademark of the American Medical Association.

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