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modifier 53 if patient refused procedure?

  1. #1
    Default modifier 53 if patient refused procedure?
    Medical Coding Books
    Hi, I am hoping someone can answer this question. The patient was prepped and ready for colonscopy. When anesthesiologist put IV in, very quickly pt got agitated and wanted it stopped, so no actual procedure was done, only the beginnings of the anesthesia. Would I bill this as an office visit? or bill procedure and anesthesia with one of the modifiers? maybe 53? discontined? even though it really was the anesthesia that was discontinued? Please help.

  2. #2
    Columbia, MO
    As long as the patient was in the room where the procedure was to be performed and your physician writes a note detailing what was done and the patients decision the you may bill the colonoscopy with the 53. Also as your 2nd listed dx code use V64.2 which indicates procedure not carried out due to pt decision.

  3. Default
    This is a tough one. Was the anesthesia administration begun, or simply that the needle was inserted? Where was the patient located? (in the room the procedure was to be performed? somewhere else?) Is the place of service an ASC?

    In the CPT book, Mod 53 indicates that it is not used to report the elective cancellation of a procedure prior to induction of anesthesia.

    I believe that the anesthesia status is going to be your deciding factor. If this is an ASC, you can also look at mod 73 if anesthesia not started, or 74 if anesthesia was started.

  4. #4
    San Antonio, Tx
    The anesthesiologist can bill with a modifier 53 if she/he actually punctured the skin. Your Doc can bill an office visit if all of the requirements are met for that level of visit. If the requirements are not met, then you may be able to bill the same as a no show, which is usually equivalent to the co-pay. I have done both of these before. Worked for me.
    Ray Galvez CPC

  5. #5
    Columbia, MO
    What we need to know to offer the best answer is who are you coding for? The facility, the surgeon, the anesthesiologist? As you can see many different answers. My answer is for the physician performing the procedure.

  6. #6
    Default to mitchell de & others
    No medication entered pt, pt was already in the procedure room in office setting, not ASC as of now, billing for surgeon and anesthesiologist.

    Thanks for your help and thanks everyone else too.

  7. #7
    Default to rgalvez
    Could you clarify? Would I be able to bil both the office visit and the anesthesia? if the conditions are met? or must pick one or the other?

  8. #8
    San Antonio, Tx
    Yes. Anesthesia with Mod 53 and Office Visit with Mod 25. You would only append the Mod 25 if the anesthesiologist is in your group or your Dr. administered the anesthesia. You may also have to report the wastage of the anesthesia drug used in order to get credit for all of the drug. Not sure what he (the anesthesiologist/ your Dr) did since he did not administered any drugs into the pt. If your Dr was going to administer the anesthesia, then he can bill the Office Visit-25, Venipuncture and the drug-53, JW (if he had to discard it) with the Mod JW. ( Not sure what state you are in, but I use this in Texas. If you need more asisitance from me, send me a private e-mail and I will see what I can find for you. Hope this helps. The others also make very good points. That is what is so great about this thread system. Lots of info, you decide what works best for you.
    Ray Galvez CPC

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