Outpatient Facility Coding Alert
Attempted EGD Can Justify Reporting Modifier 53
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Question: The GI attempted an EGD on a patient with primary tongue carcinoma who had multiple therapies including radiation and surgery. The physician failed to advance the scope through the upper esophageal sphincter due to either a radiation stricture or an occlusion. How should I report this procedure?
Maine Subscriber
Answer: If reporting the professional component, your case warrants the use of modifier 53 (Discontinued procedure). This modifier indicates that a surgical or diagnostic procedure was started but discontinued. Pay attention to the additional note in its descriptor, which states that “This modifier is not used to report the elective cancellation of a procedure prior to the patient’s anesthesia induction and/or surgical preparation in the operating suite.”
Bill the procedure with 43235 (Esophagogastroduodenoscopy, flexible, transoral diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]) appended by modifier 53.
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