Modifier 53 on 1st aborted proc, what modifer on 2nd-diff approach??

katwright

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My Neurosurgeon planned to do 22600, 22614, 22842, 63045, 63048 X2, 20930. This procedure was aborted due to blood pressure drop when patient was placed prone. We billed these out with 53 modifier since anesthesia was administered. Pt was kept in hospital and 2 days later he did Anterior approach surgery, 22551,22552,22845,22851 X2, 20930. What modifier to I append to the second surgery?
 

katwright

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I was thinking maybe 58?? He knew at the time when the pt's pressure dropped in the prone position he would come back and do an anterior approach.
 

ckirkp1

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I still think you would use modifier -78 because the dr didn't intend/planned to abort the procedure. The pt had an unexpected drop in blood pressure. To me the dr would never begin the procedure if he knew pt's blood pressure was very low. Pt blood pressure was probably stable at the time procedure begin. In this case I don't think it was intentional. The dr probably knew the risk but I don't think he planned it that way. I still believe he didn't plan to abort the procedure. He probably thought out plan 2 if something went wrong with plan 1. To me using modifier -58 means it was intentional/staged. I hope I make sense. But that is just my opinion.
 
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katwright

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I asked someone from the office next door and she said I don't have to put a modifier on the 2nd procedure since I put a 53 on the first. Not sure I agree with that either...
Back to 58 or 78, yes I do see that we should use 78 in that scenario.
 

ewinnacott

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Is the doctor planning on doing the initial posterior procedure or are they just doing the anterior and not bothering to try the posterior again at a later date? I think your modifiers all depend on that in my opinion. Since the surgeon did not make an incision according to your first post then the -53 does not apply. I had a similar issue where the surgeon and staff were waiting for the patient's EEG to be normal and when it didn't they aborted the procedure and we couldn't charge anything for the surgeon's time. After doing research I found that unless an initial incision was made a modifier -53 does not apply. I would possibly code the anterior surgery with no modifier and if they decide to do the posterior then apply a mod -58 to that surgery. Hope this helps!
 
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