CPC Certification Hyderabad

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MODIFIER 53
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MODIFIER 53

• Modifier 53 Discontinued Procedure Under certain
  circumstances, the physician may elect to
  terminate a surgical or diagnostic procedure. Due
  to extenuating circumstances, or those that
  threaten the well-being of the patient, it may be
  necessary to indicate that a surgical or
  diagnostic procedure was started but
  discontinued. Medical Coding Training in Hyderabad

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MODIFIER 53

• For hospitalists, I believe most of the time we
  should be using modifier 53 on our procedures
  (central line, thoracentesis, paracentesis,
  lumbar puncture) that are discontinued before
  completion. Most of the time a procedure is
  aborted, it will be because of anatomical
  reasons, medical stability reasons or agitation
  that prevents a safe completion.

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WHEN TO USE

• Use of procedures that are terminated prior to
  completion. I provide a special review of
  colonoscopy due to additional guidance by CMS.
• Use if the surgery or procedure is
  discontinued after anesthesia is administered.
• Use for the discontinued procedure after
  induction of anesthesia.

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WHEN TO USE

• Use if equipment malfunction prevents
  completion of the intended procedure.
• Use if the procedure is terminated for reasons
  beyond the physician's control. This would
  appear to qualify as an extenuating circumstance.
• Use when the patient is having a complication
  of the procedure.
• Use when the patient cannot tolerate the
  procedure.

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WHEN NOT TO USE

• Don't use modifier 53 with E/M services.
• Don't use modifier 53 with time-based codes.
• Don't use when converting a laparoscopic or
  endoscopic intervention to an open intervention.

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WHEN NOT TO USE

• Do not use for elective cancellation of a
  surgery or procedure.
• Don't use for discontinued surgeries prior to
  anesthesia induction or surgical prep.
• Not for use by ASCs. They are instructed to
  use modifiers -73 and -74. See below.

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DOCUMENTATION

• Provide operative report documenting why and at
  what point in the procedure it was medically
  necessary to discontinue. If the procedure was
  not surgical, provide a statement or report
  detailing how the procedure that was done
  differed from usual.
• Provide the length and amount of procedure
  completed and the reason for discontinuing the
  procedure.

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REIMBURSEMENT

• Reduce the normal fee by the percentage of the
  service you did not provide.
• Ultimately, you're gonna get paid whatever the
  insurance company says they're going to pay you
  and you'll have to go through whatever appeals
  process they have in place for denials or
  reductions in claims if you want payment for your
  services.

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REIMBURSEMENT

• From Medicare Claims Processing Manual Chapter
  13 page 52/73 on Section 80.1 regarding physician
  presence for Supervision and Interpretation (SI
  codes) and Interventional Radiology
• Radiologic supervision and interpretation
  (SI) codes are used to describe the personal
  supervision of the performance of the radiologic
  portion of a procedure by one or more physicians
  and the interpretation of the findings. In order
  to bill for the supervision aspect of the
  procedure, the physician must be present during
  its performance.

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