tci Outpatient Facility Coding Alert - 2016 Issue 1

Reader Question: Get All the Details Before Appending Modifier 53

Question: One of our patients was scheduled for paracentesis but it was cancelled after an ultrasound procedure couldn’t be completed because there wasn’t enough fluid. Do I just bill for the ultrasound guidance code 76942 or should I bill for the paracentesis with image guidance 49083 with a 53 modifier? Pennsylvania Subscriber Answer: Because your physician cancelled the paracentesis procedure (49083, Abdominal paracentesis [diagnostic or therapeutic]; with imaging guidance), you can’t bill a code for that procedure. Because the ultrasound procedure 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision...

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