Failed attempt of hysteroscopy in outpatient setting

[amanda.hackett@auihealth.com]

Our physician attempted and failed a hysteroscopy with D& C. the procedure was aborted due to the suspected uterine perforation. This was done in a outpatient facility. Would you amend modifier 53 in this case?

 

[trarut]

You mention it was done in an outpatient facility - was anesthesia involved? If so, look at modifier 73 or 74. Otherwise I would report a 53 modifier...and be prepared to appeal with medical records

 

[csperoni]

Yes, if you are billing for the physician, then -53 is appropriate. -73 and -74 are for the facility billing.

 

[trarut]

Yes, if you are billing for the physician, then -53 is appropriate. -73 and -74 are for the facility billing.

I have always read the -73 and -74 to also be options for the physicians. Thanks for the clarification!

 

[csperoni]

Here are 2 good AAPC articles for reference - 1 about -52 vs -53, the other regarding -52/-53 vs -73/-74.

https://www.aapc.com/blog/42008-know-the-difference-between-modifiers-52-and-53/

https://www.aapc.com/blog/42791-modifiers-52-and-53-vs-73-and-74/