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).


 

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This question was answered in an edition of our Radiology Compliance Manager. For more hot topics relating to radiology services, please view our store, or call us at 1.800.252.1578 ext. 2.

 

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.