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TOPIC: Coding and billing aborted/discontinued procedures

HIM Connection, December 23, 2003

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TOPIC: Coding and billing aborted/discontinued procedures

The Medicare Hospital Manual, section 440, B, 2e, "Aborted or discontinued ASC surgical procedures," instructs hospitals to report the appropriate ICD-9-CM diagnosis code (V64.1, V64.2, or V64.3) on the bill. If the procedure was discontinued before or after anesthesia was induced, report the procedure using the appropriate CPT/HCPCS code with a modifier.

As you can see, the Medicare reporting requirement for aborted/discontinued procedures, effective July 1, 1998, requires hospitals to report the ICD-9-CM diagnosis codes:

V64.1: Surgical or other procedure not carried out because of contraindication.

V64.2: Surgical or other procedure not carried out because of patients' decision.

V64.3: Procedure not carried out for other reasons.

Many hospitals are not able to report the V64 codes on their UB-92 claim form when there are operating room charges associated with the procedure. For example, a Medicare patient diagnosed with cholelithiasis was scheduled to have a laparoscopic cholecystectomy performed. After anesthesia was administered, the surgeon was unable to perform an exploratory laparoscopy. Due to the patient's elevated blood pressure, the surgeon was not able to complete the cholecystectomy (gallbladder removal). The patient had no history of hypertension. Per Medicare modifier guidelines, this case would be coded as:

ICD-9-CM diagnosis codes: 574.20 (cholelithiasis), 796.2 (elevated blood pressure reading), V64.1 (surgical procedure not carried out).

CPT and modifier assignments: 47562-74, (laparoscopy, surgical; cholecystectomy-discontinued outpatient hospital/ambulatory surgery center/ASC procedure after administration of anesthesia)

Note: UB-92 claim forms must include all of the codes and the modifiers listed above.

Even if a coder were to report this, at many hospitals, the V64 code would not be acceptable to the hospital's financial system because the system would not be able to accept a V64 code when there are operating room charges or the laparoscopy procedure itself even though it was not completed. Many coders not able to report this code will not do so in order to ensure that all codes go out the door. Even though coders and hospitals will be able to comply with the -73 and -74 modifiers, for aborted/discontinued procedures, coders may have difficulty reporting the V64 code.

Our recommendation is that the HIM professional work closely with their patient accounts/business office colleagues to implement this Medicare reporting requirement even if it means revising the financial system reporting requirements. These guidelines must be adhered to and hospitals must be able to track these cases where procedures were not carried out in their entirety. Hospitals should consider preparing manual bills if the billing system will not "allow" the reporting of a V64 diagnosis and CPT code.

This weeks excerpt from "The Modifier Clinic: A guide to hospital outpatient issues," by Lolita M. Jones, RHIA, CCS.

Click here for more information or to order.

Kate Alvarez
Editorial Assistant
kalvarez@hcpro.com

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