• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Modifier -53 on HCPCS codes

johnbouis

New
Messages
5
Location
San Diego, CA
Best answers
0
Is modifier -53 (discontinued procedure) valid on HCPCS codes (specifically G0121 screening colonoscopy) or is it only intended for CPT codes.
My research has drawn a blank either way. Thanks for any reference about this.
 
Hi - Mod 53 can be payer- and setting-specific, but Medicare includes a row for G0121 with modifier 53 in the Physician Fee Schedule with code status A. https://www.cms.gov/medicaremedicar...sicianfeeschedpfs-relative-value-files/rvu22a

In Medicare Claims Processing Manual, Chapter 12, Section 30.1.B, there is this info:
B. Incomplete Colonoscopies (Codes 44388, 45378, G0105 and G0121)
An incomplete colonoscopy, e.g., the inability to advance the colonoscope to the cecum or
colon-small intestine anastomosis due to unforeseen circumstances, is billed and paid using
colonoscopy through stoma code 44388, colonoscopy code 45378, and screening colonoscopy
codes G0105 and G0121 with modifier “-53.” (Code 44388 is valid with modifier 53
beginning January 1, 2016.) The Medicare physician fee schedule database has specific values
for codes 44388-53, 45378-53, G0105-53 and G0121-53. An incomplete colonoscopy
performed prior to January 1, 2016, is paid at the same rate as a sigmoidoscopy. Beginning
January 1, 2016, Medicare will pay for the interrupted colonoscopy at a rate that is calculated
using one-half the value of the inputs for the codes.

Hope that helps!
 
Top