billing for incomplete procedure

[promethius]

Hey for those who are doing their own billing, what is the correct way to bill for an incomplete procedure that was attempted in the office setting? I was recently in the middle of doing an intraspinal injection under local anesthesia, but the patient started having an anxiety attack, and the procedure ended up being canceled.

I heard we can use modifier 53 with the CPT code for the injection, but not sure if that is the best way to code it for this situation. What about the injectants? Are we allowed to bill for the steroids and contrast that were drawn up and ended up being thrown away (with or without the 53 modifier)? How much do insurance companies usually reimburse for an incomplete procedure (relative to the completed procedure)? Thank you.

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[ppatel1185]

They may request records, or reimburse you something much lower without asking for records. Modifier 53 is the appropriate way to bill it from my experience.

 

[BobBarker]

Modifier 53.

 

[painfree23]

Hey for those who are doing their own billing, what is the correct way to bill for an incomplete procedure that was attempted in the office setting? I was recently in the middle of doing an intraspinal injection under local anesthesia, but the patient started having an anxiety attack, and the procedure ended up being canceled.

I heard we can use modifier 53 with the CPT code for the injection, but not sure if that is the best way to code it for this situation. What about the injectants? Are we allowed to bill for the steroids and contrast that were drawn up and ended up being thrown away (with or without the 53 modifier)? How much do insurance companies usually reimburse for an incomplete procedure (relative to the completed procedure)? Thank you.

R u typically billing for contrast?

 

[ppatel1185]

R u typically billing for contrast?

I have never billed for contrast. I thought that was bundled in. Does contrast pay?

 

[smarterchild]

I usually bill q9966 for contrast. Reimbursement is usually 0.63 to $1.00

 

[painfree23]

I have never billed for contrast. I thought that was bundled in. Does contrast pay?

I thought it was bundled too

 

[jsaul]

I cant believe we are worrying about proper coding for omnipaque that reimburses less than $1.00 and reimbursement for steroid usually between 4 to 8 dollars. They (INSURANCE COMPANIES) are laughing at us.The whole situation is ridiculous.

 

[painfree23]

I cant believe we are worrying about proper coding for omnipaque that reimburses less than $1.00 and reimbursement for steroid usually between 4 to 8 dollars. They (INSURANCE COMPANIES) are laughing at us.The whole situation is ridiculous.

Well if u do 1000 epidurals a year, $1 omnipaque billing is enough for a really nice Christmas luncheon for ur staff .

 

[promethius]

They may request records, or reimburse you something much lower without asking for records. Modifier 53 is the appropriate way to bill it from my experience.

Just as a follow-up to this question, I submitted the claim to my state's Medicaid with the addition of modifier 53 to the procedure CPT code and got reimbursed 100% of the allowed amount without having to submit any medical records.

R u typically billing for contrast?

Yes, I bill for contrast, as payment for neither contrast nor steroid is bundled with the procedure. Q9966 is the appropriate CPT code for billing for contrast, but as smarterchild pointed out, reimbursement for a unit of contrast is usually less than $1.

 

[myrandom2003]

Just as a follow-up to this question, I submitted the claim to my state's Medicaid with the addition of modifier 53 to the procedure CPT code and got reimbursed 100% of the allowed amount without having to submit any medical records.

Let us know if they come back and try to claw that money back