Wiki Modifier 53 on Knee Injection

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Mmljar

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Would modifier 53 be appropriate for a knee injection that was discontinued after two attempts (but after local anesthetic was given)? This is for a physician's office. Thanks.
 
Thank you for the info. Are you thinking the 53 would not be used in this case because of why the procedure was discontinued - since it was unsuccessful versus threatening the well being of the patient?

The CPT code being used is 20610. Maybe modifier 52 would be better or possibly this should not be billed at all.

Thank you.
 
First I would say to review the documentation and determine why the injection didn't end up happening (why it was 'unsuccessful'). There's multiple reasons why that may be, and that rationale may lead us to the correct answer for this one. Can you send that information back through?

Kris
 
The physician did not elaborate on why, just documented two failed attempts and that it was not accomplished. Local anesthetic was given. This was an euflexxa injection.

Thanks.
 
Okay, well if you think that if you gave the insurance carrier what the physician wrote about the failed attempts that they would make payment, then perhaps you don't need to make an additional query or ask for further documentation. In that case, simply "failed attempts", then modifier 52 would seem to best fit the situation. In the local use text field of the claim enter "Documentation Available Upon Request", and reduce the charge to what would be appropriate for the provider's work that day.

But if you question it at all, then I would recommend making at least an attempt, letting your provider know that you want to be sure that if the carrier asks for the documentation, you will be certain that what is there will support him/her getting payment for the attempts.

Not sure if this will help, but WPS Medicare Part B, for Michigan, has a modifier 52 fact sheet that can be found at:

http://www.wpsmedicare.com/part_b/education/modifier_52.pdf

Kris
 
Provider has been queried and am waiting response (provider was out for conference). It's a great help to have it narrowed down to 52 or 53 so will be informed when I hear back from him.

Thank you so much for your help!
 
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