modifier 53 - cancelled surgery after induction

phenderson

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Hi,
I have been to many seminars and they all instruct to use modifier 53 for a cancelled surgery after induction. We have been getting denied by United and Medicare stating the 53 is a surgical modifier and is not to be used for Anesthesia claims. Has anyone else had this problem?
Thanks,
Pam
 

NaliniAAPC

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Hi,

We are also using 53 modifier for case cancelled procedure after induction and diagnosis code V64.3..

Regards,
Nalini CPC.
 

dwaldman

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http://www.wpsmedicare.com/part_b/education/modifier_53.pdf

In the above link it says do not place on time-based codes they don't mention anesthesia codes but that statement brings up questions if anesthesia codes are what the also mean by time based codes they give an example of critical care codes as time based codes. They define 53 modifer

"Indicates the physician elected to terminate a surgical or diagnostic procedure due to the patient's well-being"

They require pre payment review for a surgical procedure if you would send it electronically they would not be able to pay without reviewing the notes and pertinent information like how much of the procedure was completed. In the definition it says terminating a surgical or diagnostic procedure, but can you really call anesthesia codes---surgical or diagnostic codes. With that in mind, it makes sense they might not accept 53 on an anesthesia code. If the anesthesia time is only 10 minutes before it was terminate the question is even worth reporting. They typically reschedule the surgery at later date and then the full case is reported then. This might be the most accurate advice and I saw your other response that states they bill the 53 modifier and are not having any issues. My policy I am using is that, the anesthesia for the surgery will be reported when they are able to get the pre op clearance to do the surgery at a later date and that is when I will bill the anesthesia for a completed case.
 

brockorama01

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I believe the 53 modifier would be inappropriate for the anesthesia services since it typically only relates to surgeons.

Wouldn't it be appropriate to just bill the anesthsia time as documented until the procedure stopped or anesthesia care was ceased? The discontinued service modifiers would be important to the surgery center and the surgeon but not to the anesthestist.

Brock Berta
Resident Wacko Billing Mgr
 

twizzle

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Modifier 53 (and 52)

I have the same issues but the more I think about it the more it makes sense NOT to put it on anesthesia codes. If a procedure is terminated prematurely then, as far as billing anesthesia is concerned , there is less time to bill for, which in itself is reflected by 52 and 53. The use of these modifiers for the surgeon has much the same effect in reimbursement as reduced time for the anesthesia service.
Does that make sense?
 

phenderson

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modifier 53

Thank you all for your responses. It does make sense the more you think of it not to use the modifier 53. The Anesthesia time is less, because the surgery was cancelled. The V64 codes also clue the insurance carrier that the surgery was cancelled. Thanks again everyone for your help.
Pam
 
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