Korbc
Guru
hey guys,
my practice has always put 53 on cases of a failed procedure, like a failed attempted endo biopsy etc., but now I'm wondering if it should be 52 instead for at least the attempted work, same with ultrasounds where viability wasn't determined because they couldn't see, any opinions on this? I found this in an older ob/gyn coding newsletter. It states to use 53 just if they discontinued because the patient couldn't physically tolerate the procedure as in something went wrong physically but doesn't state anything regarding if something was attempted and couldn't be completed due to anatomy or adhesions etc... Thanks so much
Understanding Modifier -53 Key to Getting Paid
Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies Inc., in Dallas, GA, a coding and reimbursement consulting firm, explains that modifier -53 indicates the physician could not complete the procedure because the patient had a problem. The CPT clearly defines -53 as a stopped or terminated service, adds Witt. Discontinued means stopped, whether the patient was in surgery or whether you had her in the stirrups in your office. Its when everything comes to a grinding halt and nothing else is done to that patient, Witt describes.
Modifier -53 is for circumstances in which a diagnostic or surgical procedure is terminated because of circumstances that threaten the well-being of the patient, she emphasizes. This isnt for the patient who says half way through the procedure, Oops, I dont want to do this
now. There has to be a situation affecting the well-being of the patient, for example, her blood pressure dropped or she started bleeding dramatically, so you had to stop, Witt says.
my practice has always put 53 on cases of a failed procedure, like a failed attempted endo biopsy etc., but now I'm wondering if it should be 52 instead for at least the attempted work, same with ultrasounds where viability wasn't determined because they couldn't see, any opinions on this? I found this in an older ob/gyn coding newsletter. It states to use 53 just if they discontinued because the patient couldn't physically tolerate the procedure as in something went wrong physically but doesn't state anything regarding if something was attempted and couldn't be completed due to anatomy or adhesions etc... Thanks so much
Understanding Modifier -53 Key to Getting Paid
Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies Inc., in Dallas, GA, a coding and reimbursement consulting firm, explains that modifier -53 indicates the physician could not complete the procedure because the patient had a problem. The CPT clearly defines -53 as a stopped or terminated service, adds Witt. Discontinued means stopped, whether the patient was in surgery or whether you had her in the stirrups in your office. Its when everything comes to a grinding halt and nothing else is done to that patient, Witt describes.
Modifier -53 is for circumstances in which a diagnostic or surgical procedure is terminated because of circumstances that threaten the well-being of the patient, she emphasizes. This isnt for the patient who says half way through the procedure, Oops, I dont want to do this
now. There has to be a situation affecting the well-being of the patient, for example, her blood pressure dropped or she started bleeding dramatically, so you had to stop, Witt says.