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Take the ache out of coding discontinued IR procedures

HIM Connection, April 11, 2006

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Although CMS states that hospitals should report modifier -52 (reduced services) when radiology procedures that do not require anesthesia are discontinued, many interventional radiology (IR) procedures involve the use of anesthesia. In this column, Lolita Jones, RHIA, CCS, of Lolita M. Jones Consulting in Fort Washington, MD, discusses how OPPS hospitals should code these procedures.

As a recap, IR procedures are minimally invasive, targeted treatments that use imaging for guidance. These procedures have been found to be less risky and painful and have a shorter recovery time than open surgery, notes Jones. Unlike traditional radiology procedures, some IR procedures require anesthesia. Unfortunately, CMS has not specifically addressed the use of modifier -52 in these situations. "In the absence of a formal [written] directive from CMS or their fiscal intermediary [FI], hospitals need to develop an internal policy that addresses the use of modifier -52 or -73/-74 for discontinued IR procedures that involve anesthesia," Jones says.

Guidelines for discontinued single procedures

Following are the official guidelines for modifiers -52, -73, and -74, as published in CMS Transmittal 442, Hospital OPPS: Use of modifiers -52, -73, and -74 for reduced or discontinued services. All of the definitions took effect February 22, 2005. For purposes of billing for services furnished in the hospital outpatient department, the definition of anesthesia includes local, regional blocks, moderate sedation/analgesia (i.e., conscious sedation), deep sedation/analgesia, or general anesthesia:

• Modifier -73: Use this modifier to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated due to extenuating circumstances or circumstances that threatened the patient's well-being after he or she had been prepared for the procedure (including procedural premedication when provided) and taken to the room in which the procedure was to be performed, but prior to administration of anesthesia.
  
• Modifier -74: Use this modifier to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated after the induction of anesthesia or after the procedure was started (e.g., the incision was made, intubation was started, and the scope was inserted) due to extenuating circumstances or circumstances that threatened the patient's well-being.
  
• Modifier -52: Use this modifier to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia.

Guidelines for scheduled/discontinued multiple procedures

Use the following guidelines to report discontinued procedures that the hospital planned to perform with other procedures during the same patient visit:

• Report completed procedures as usual when staff complete one or more of the planned procedures. Do not report the other(s) that were planned but not started. If a physician starts the first procedure (e.g., scope inserted, intubation started, incision made, etc.) or the patient has received anesthesia, use modifier -74. Do not report the other procedures.
  
• Do not report the procedure if it is terminated prior to the induction of anesthesia and before the patient is wheeled into the procedure room. "The patient has to be taken to the room where the procedure is to be performed in order to report modifier -73 or -74," Jones says.
  
• Use modifier -73 or -74 as appropriate for discontinued pain management procedures (e.g., diagnostic and therapeutic spinal injections) if these procedures involve the use of anesthesia.

Editor's Note: This article was adapted from the newsletter Briefings on APCs published by HCPro, Inc.

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