Question 53 modifier

cherylbr

Networker
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60
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0
Here is my scenario which I need help coding: Patient was to undergo cataract surgery and passed out in the OR. No anesthesia was administered and the case was cancelled. For billing for the facility I believe I am okay bill the 66984 with a 73 modifier along with the laterality code. However, my question comes into play with billing for the provider himself. Is it appropriate to bill 66984 with a 53 modifier? At what part of the start of admission for the procedure qualify the use of 53 modifier? If the patient passed out in the or and did not even have anesthesia or surgery can we still bill the planned operative code with the 53 modifier? What documentation would need to accompany the billing for this? Do we need an operative report describing what happened even though there was no operative procedure?

Please Help! I'm so confused about this. Any input would be so appreciated!

Thank you!
Cheryl
 

SharonCollachi

True Blue
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793
Location
Clovis, CA
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3
Mod 53 means the procedure was started but was not completed. Modifier 52 means the service was completed but is less than normally provided.

Here is info from this website:
It is important to know that Modifier 53 and Modifiers 73 and 74 are very different. Modifier 53 has the caveat that the procedure was discontinued due to the well-being of the patient after the induction of general anesthesia. Whereas modifiers 73 and 74 have no requirement that the patient’s well being be tied to the procedure’s discontinuance. The surgeon cannot use modifier 53 if the procedure has been discontinued prior to general anesthesia being administered to the patient. And the surgeon cannot use modifier 53 if a procedure that is being performed under local anesthesia has been discontinued, even if it is for the patient’s well-being, for example, because the patient is experiencing more pain than they can bear under a local. The surgeon has fewer options than facilities when it comes to coding and billing for reduced and discontinued services. One of the reasons that the facilities have more latitude with modifiers 73 and 74, for discontinued procedures before and after the administration of anesthesia is because of the costs involved in setting up an operating room.

There is no cost to the provider, so he doesn't get to bill, if the procedure was stopped before anesthesia.
 
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