Q&A: Coding a multi-part procedure that ends prematurely

October 6, 2017
Medicare Web

Q: For a ureteroscopy intended as a procedure with a biopsy and double-J stent, if the procedure ends when only the scope was placed before a biopsy was taken, could you just code ureteroscopy instead of coding it with the biopsy and the modifier-74 (discontinued outpatient hospital/ambulatory surgery center procedure after administration of anesthesia)?

A: So the scenario here is we're planning an ureteroscopy with biopsy and we're planning the double-J stent. Anesthesia is given, the scope is put in, and then the procedure is stopped prematurely. In this scenario, there hasn’t been enough done to qualify as a diagnostic ureteroscopy yet. The scope is in and then the procedure is stopped before we did anything. The answer for coding here is to be reasonable about it.

If, in preparation for the procedure, you have costs for equipment or whatever materials that are not fully used but now have to be either restocked or reclaimed for the planned procedure, then you should report the planned procedure with modifier -74. But if the cost that you've incurred so far would not rise above whatever a diagnostic ureteroscopy would be, then it is perfectly fine to bill for the diagnostic ureteroscopy.

It’s likely the patient is going to have to come back in to have something done. Remember, it doesn’t reduce your reimbursement for the ureteroscopy, but it sets the stage for why the patient may re-present for something else. You have options here to choose the diagnostic ureteroscopy with biopsy if you think that better represents your cost, because the guidelines say to report the planned procedure with modifier -74. Just don’t code that double-J stent for this scenario. 

Editor’s Note: Susan E. Garrison, CHCA, CHCAS, CCS-P, CHC, CPAR, CPC, COC, answered this question during the HCPro webinar, “Overcome 2017 OPPS Modifier Reporting Challenges.

This answer was provided based on limited information. Be sure to review all documentation specific to your individual scenario before determining appropriate action.

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