53 Modifier for Incomplete Procedure

missyah20

Guru
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Minneapolis
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Good Afternoon,
I have an anesthesia charge for an Incomplete EGD for an Inpatient. The case was stopped due to Rapid Heart Rate. We did bill this with a 53 modifier and Medicare has denied as, "Procedure code inconsistent with modifier or modifier missing."

Can anyone help me out with what to do next. This denied with remit code MA130 so I have to resubmit this - there are no appeal rights.

Thanks!
 

dwaldman

True Blue
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When should I utilize Modifier 53 (Discontinued Procedures)?
Appropriate usage guidelines for Modifier 53 instruct that, under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Extenuating circumstances or those that threaten the well-being of the patient may make it necessary to indicate that a surgical or diagnostic procedure was started, but discontinued.

Any procedure code billed with modifier 53 will be subject to carrier medical review. Supporting documentation in the patient medical records must be available upon request. Reimbursement will be made on an individual basis. Refer to WPS Medicare's Modifier 53 Fact Sheet for examples of appropriate and inappropriate use of Modifier 53.

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Does not seem anesthesia service would be included in "surgical or diagnostic procedure" and therefore would not use 53 modifier with anesthesia code.
 
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Location
Muncie, IN
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Since anethesia is time based, do not report -53 with anesthesia codes.
The surgeon will report the discontinued procedure and they should also use one of the
V64 dx codes to explain why the procedure was discontinued. In this case, they would use V64.1 for procedure not carried out due to contraindication. I don't see why you couldn't apply this dx code (NOT as primary) to the anesthesia charge just to show more detail.
~Melissa, CPC:)
 

pamela brashear

Contributor
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Metamora, IL
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discontinued procedure

Can anyone tell me if a patient comes in for a Bartholin Gland Cyst and the physician was not able to drain the cyst would you charge an office visit or the attempt drainage 56440?
 
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