Carrier Helps Guide Modifier 53 Claims
Question: My provider had much difficulty with needle placement for a cervical transforaminal epidural injection. He discontinued the procedure because he returned blood -- and possibly cerebrospinal fluid (CSF) -- before injecting any medication in the epidural space. Which modifier should I report? Georgia Subscriber Answer: You usually report modifier 53 (Discontinued procedure) with the procedure code when your provider is unable to complete the service. If you're filing a Medicare case, include a note in CMS-1500 box 19 that briefly explains why your physician needed to stop the procedure. Report the procedure with 64479 (Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level) and append modifier 53 to notify the payer that your physician discontinued the procedure.
