Health Information Management

Q&A: Reporting discontinued radiology procedures

APCs Insider, December 9, 2011

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Q: Our radiologist attempted to perform a barium enema with air contrast. However, the radiologist could not complete the examination because because the patient became incontinent of barium after several attempts to fill the colon with barium. The radiologist documented “limited evaluation of the colon” and the results of the films. Would reporting this exam with modifier -74 (discontinued outpatient procedure after anesthesia administration) be appropriate? If not, how should we report this exam?

A: Modifier -74 is not be the correct modifier because anesthesia was not administered. Modifiers -73 (discontinued outpatient procedure prior to anesthesia administration) and -74 are generally the most appropriate modifiers for discontinued surgical type procedures. The CMS Claims Processing Manual , Chapter 4, §20.6.6, addresses radiology modifiers and reporting discontinued procedures:

When a radiology procedure is reduced, the correct reporting is to code to the extent of the procedure performed. If no HCPCS code exists for the service that has been completed, report the intended HCPCS code with modifier -52 [reduced services] appended.

Based on the documentation provided, it is unclear whether any HCPCS code describes the extent of the exam performed. You should review the report of the procedure in detail and determine whether any code describes the portion of the procedure that was performed or whether you should report the code for the intended procedure with modifier -52.

Editor’s note: Denise Williams, RN, CPC-H, director of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

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