Author Topic: Billing for Non Compliant Patients  (Read 2858 times)

SOMB

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Billing for Non Compliant Patients
« on: September 23, 2010, 07:31:21 PM »
I have a client who operates a sleep lab and he is having problems with some patients being non compliant during the services. As and example: Patient reported for over night sleep lab at 8pm. Patient was set up for the overnight sleep lab however at 1:30am patient got up and decided he was not going to finish the test and walked out.

I have not been able to find a modifier that is specific to this. I was thinking that I would need to use a modifier 53 however  it specifically states that the test was stopped by the provider and that was not the case in this instance. Has anyone else had this problem? Would I bill using a modifier 53?

oneround

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Re: Billing for Non Compliant Patients
« Reply #1 on: September 23, 2010, 09:40:09 PM »
Good question.  I would lean more towards the -52.  I'll shot this amoungst my peers to see their thoughts
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

Michele

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Re: Billing for Non Compliant Patients
« Reply #2 on: September 23, 2010, 10:44:05 PM »
It is a good question.  My husband's uncle did the same thing.  I was leaning toward the 52 also, but I haven't ever billed this.

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PMRNC

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Re: Billing for Non Compliant Patients
« Reply #3 on: September 24, 2010, 11:53:18 AM »
I found this which MOSTLY relates to anesthesia and modifiers 52 and 53, but if you scroll down the last post is in regards to sleep studies ending early: http://codingstrategy.com/category/modifier-52/ 

Earlier on than that section it also says you should charge your full fee when appending the 52 modifier and let the carrier reduce the charge, if you cut the fee, then the carrier could again cut it again.
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Re: Billing for Non Compliant Patients
« Reply #3 on: September 24, 2010, 11:53:18 AM »