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    How to bill for discontinued vasectomy procedure

    Reason for stopping procedure will dictate proper choice of modifier

    Ray Painter, MDRay Painter, MD Mark PainterMark Painter

     

    I was performing a vasectomy in the office but had to discontinue the procedure because the patient could not tolerate it. The incision had been made. Should I bill this with the –53 modifier or should I bill an E&M service? The procedure was performed 2 days later in the outpatient surgery center under sedation.

    The first procedure should actually be billed with the –52 modifier (Reduced Services), not the –53 (Discontinued Procedure). The –53 modifier should be used if the procedure was discontinued due to extenuating circumstances that threaten the patient’s well-being.

    Also by the Painters: Proposed MIPS rule modifies 2018 requirements

    In addition, be sure the operative note documented that the procedure would be performed at a later date. The second procedure should be billed with the –58 modifier (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period), since it was performed in the global of the first procedure, was planned, and was not a complication. The –76 modifier (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional) would be appended since this is a repeat procedure code. Modifier –76 is informational only but would send a message that this is not a duplicate charge.

    Next: Charging based on time

    Ray Painter, MD
    Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver, and is also publisher of Urology Coding and ...
    Mark Painter
    Mark Painter is CEO of PRS Urology SC in Denver.

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