Modifier 53: Appropriate Use
Modifier 53: Discontinued Procedures
As per Appendix A of CPT: ‘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. This circumstance may be reported by adding the modifier 53 to the code reported by the physician for the discontinued procedure. Modifier 53 might also apply if the provider must stop a procedure due to equipment failure or other extenuating circumstances.
Under certain circumstances, the provider may elect to terminate a surgical or diagnostic procedure due to circumstances that may threaten the well-being of the patient. Submit CPT modifier 53 with surgical codes or medical diagnostic codes when the procedure is discontinued because of extenuating circumstances. This modifier is used to report services or procedure when the services or procedure is discontinued after anesthesia is administered to the patient.
- Unusual (discontinued) circumstances.
- A discontinued procedure after induction of anesthesia.
- Append modifier to the discontinued procedure’s CPT code
- To report an elective cancellation of a procedure prior to the patient’s anesthesia induction and/or surgical preparation in the operating suite
- When used on E/M services
- For outpatient hospital/ ambulatory surgical center
- To report an elective cancellation of a procedure prior to the patient’s anesthesia induction and/or surgical preparation in the operating suite.
Modifier 53 is considered valid on a maximum of one procedure code per date of service. When multiple procedures were planned:
- When none of the planned procedures is completed, then the first planned procedure is reported with modifier 53. The other planned procedure(s) are not reported.
- Modifier 50 and modifier 53 may not be reported together on the same procedure code
- When a bilateral procedure is planned and discontinued before either side is completed, only a unilateral procedure code may be reported with modifier 53.
- If one or more of the procedures planned is completed, the completed procedures are reported as usual. The other procedure(s) that are discontinued or not completed are not reported and are not eligible for separate reimbursement.
- Providers will be reimbursed for one discontinued procedure with modifier 53. Additional discontinued procedures for the same date of service are not eligible for reimbursement.
Payment for discontinued procedures is based on the percentage of service completed. Documentation should provide substantial detail to allow the payer to make a reimbursement determination.
The medical record must include documentation that the procedure was started, why the procedure was discontinued, and the percentage of the procedure that was performed. This supporting documentation must be available for review upon request.
- Supporting documentation should:
- State when the procedure was started
- Explain why the procedure was discontinued
- Notate the percentage of the procedure that was performed
- Additional information to support the modifier can be written in the narrative of claim. If data cannot be written in the narrative, documentation must be submitted.
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We hope this article would have given you all the necessary information to use modifier 53 appropriately. If you are still not sure and need help in medical billing for your practice, you can always contact us. E2E Medical Billing Services has an experienced billing and coding team that uses exact modifiers to bring accurate insurance reimbursement. To know more about our medical billing services call us at 888-552-1290 or write to us at [email protected]