CPT Coding Q & A on Multiple Attempts of the Same Procedure

Q:  Can someone please advise on the following?
IV team attempts to insert a PICC and is unsuccessful. We try a 2nd time on the other arm with another nurse. Would it be appropriate to report both the unsuccessful and successful insertions?
We would bill the unsuccessful PICC with a modifier 52 and the successful PICC with no modifier (CPT 36556).
I found the following information in the Medicare Claims Processing Manual Chapter 4 – Part B Hospital (Including Inpatient Hospital Part B and OPPS):
“Procedures for which anesthesia is not planned that are discontinued, partially reduced or cancelled after the patient is prepared and taken to the room where the procedure is to be performed will be paid at 50 percent of the full OPPS payment amount. Modifier -52 is used for these procedures.”
A:  Only one unit of 36556 with no modifier would be reported. The PICC line was successfully inserted eventually; it just took multiple attempts to accomplish it. Therefore, the first attempt would not be viewed as a reduced or cancelled separate procedure but just as a failed first attempt at a single procedure that was later successfully completed. As stated in Coding Clinic for HCPCS 3rd Qtr 2007 page 10: “Sometimes several unsuccessful attempts are made during the same operative episode to perform a procedure and finally the last attempt is successful. In this instance, only one unit of a single code would be reported for the procedure successfully accomplished, regardless of the numerous attempts. The unsuccessful attempts are considered a part of the successful procedure.”

Speak Your Mind


Powered by WishList Member - Membership Software