Q&A: Report appropriate CPT code and append modifier -52 for nuclear medicine procedures cancelled for clinical reasons
APCs Weekly Monitor, July 18, 2008
Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor!
QUESTION: I really enjoyed your Q&A, "When to bill for terminated procedures and wasted supplies in the OR" and shared it with my surgical departments.
What about radiopharmaceuticals? If the procedure is canceled after the administration of a radiopharmaceutical, how do we bill for it? There are usually two reasons for canceling at this point: the patient changes his or her mind, or complications arise and we can?t complete the scanning.
I'm not sure what to do when patients change their minds. We administer the radiopharmaceutical injection to the patient but we can't bill it without a procedure. Should we bill the procedure with modifier -52 since the radiopharmaceutical injection could be considered part of the procedure?
If complications arise and scanning is incomplete, would modifier -52 be appropriate? Scanning was attempted but not completed.
ANSWER: Your logic is correct. In cases where the nuclear medicine procedure is cancelled or not completed due to clinical reasons, report the nuclear medicine procedure with the appropriate CPT code and append modifier -52. Of course, you should also report the charge and HCPCS code for the radiopharmaceutical itself. It?s important that your medical record documentation states the clinical reason(s) that the test was cancelled or not completed. Note that modifier -52 will result in a 50% reduction of the payment rate for procedure you report.
If the patient decides not to proceed on an elective basis after the administration of the radiopharmaceuticals, it would not be appropriate to bill the procedure. Medicare only allows partial payment for terminated procedures due to extenuating circumstances or circumstances that threaten the well being of the patient. For more information on terminated procedures see the Medicare Claims Processing Manual, chapter 4, section 20.6.4.
Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor!
Comments
0 comments on “Q&A: Report appropriate CPT code and append modifier -52 for nuclear medicine procedures cancelled for clinical reasons ”
Related Products
Most Popular
- Articles
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- Catch up on what's new with injections and infusions
- Identify potential Medicaid RAC target areas
- HIPAA Q&A: Level of encryption needed for email
- Topic: CMS, OESS post new security compliance review information, checklist
- Capturing all necessary codes for IUD insertion and removal can be challenging
- What does case-mix index mean to you?
- OB services: Coding inside and outside of the package
- QA:Coding multiple initial infusions
- E-mailed
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- HIPAA Q&A: Level of encryption needed for email
- Q&A: Follow CMS' coding guidelines when using modifier -25
- What does case-mix index mean to you?
- Catch up on what's new with injections and infusions
- CMS has reformulated payments for some bilateral procedures
- New conflicts of interest create new challenges
- Q/A. One injection code or two?
- ED-to-inpatient transfers are flawed with safety gaps
- Searched