Thursday, March 17, 2011

correct and incorrect usage of 53 Modifier with example

Surgery Reminder - Using 53 Modifier

53 ModifierMay be used when the surgery must be terminated or discontinued, which means that the surgeon began the surgery intending to perform all portions of the surgical procedure; however, the patient’s given circumstances resulted in the surgeon’s decision to terminate or discontinue portions of the procedure that were originally intended to be performed.

Example of correct use of 53 modifier:

Example: After the surgical procedure was initiated and prior to completion, the patient’s vital signs diminished to a point where the provider aborted/discontinued the procedure. Operative notes must be submitted with this claim and must include documentation as to why the procedure was discontinued and at what point it was discontinued.

Example of incorrect use of 53 modifier:

Example: Colonoscopy – Scoped into descending colon with biopsy taken but procedure aborted/discontinued due to poor preparation.
Provider billed CPT code 45380© (colonoscopy and biopsy) with the 52 modifier but should have billed 45380 with the 53 modifier.

No comments:

Post a Comment

Most read cpt modifiers