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Mod 53 - one more question

  1. Default Mod 53 - one more question
    Medical Coding Books
    Had a doc who was going to perform a hip replacement. The anesthesiologist administered a regional spinal and after placement of the spinal, the patient began to defecate uncontrollably for about 15 minutes. Once this subsided, the patient was cleaned and then turned in the left lateral decubitus position to move forward with the hip replacement. The patient then began significant vomiting and it was at that time that Anesthesia cancelled the surgery.

    Should this be billed as 27130-53? This was inpatient surgery not performed at an ASC. Also, does the doctor actually need to make an incision for this to be billed? Thanks.

  2. #2
    Location
    Marrieta,Ga
    Posts
    43
    Thumbs up Mod 53 is correct
    Since the patient vomited this could have threaten the well being of the patient which was why the surgery was discontinued. In appendix A in the CPT manual it clearly states when to report mod- 53.

    Ebony, AS, CPC

  3. #3
    Location
    Marrieta,Ga
    Posts
    43
    Default Mod 53
    Also I forgot to mention the key is this scenario is that anesthesia was already given

  4. Default
    Thanks you so much for your reply. I wanted to make sure that I was reading CPT manual right. Even though he didn't cut, since this person was prepped and anesthetized it is billable with 53. I also thought that since he rolled the patient into a left lateral decubitus position and was getting ready to cut before the vomiting began, this may also be considered prepping for the surgery. Once again thanks, I'm fairly new at this and I want to make sure I get it right. Thanks!!!!

  5. #5
    Location
    Columbia, MO
    Posts
    12,531
    Default
    For Mod 53.. as long as the patient is in the room where the procedure is to be performed (and this must be documented) when the decision to discontinue occurs then you may bill the surgery with the 53 modifier. The procedure does not have to be started nor does anesthesia need to be on board.

  6. #6
    Location
    Marrieta,Ga
    Posts
    43
    Default Mod 53
    You're right Michelle I was thinking of mod 73 I get those two confused sometimes. Thanks for clearing that up.

    Ebony

  7. #7
    Location
    Eugene OR
    Posts
    12
    Default Modifier 53 & 73
    Modi 73 clearly says discontinued OP hospital/ambulatory surgery center and prior to the administration of anesthesia.
    Then it must be modi 53 only.

  8. #8
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Yes 73 and 74 are for the facility use only and 53 is for physician use only. In the facility it makes a difference for reimbursement if anesthesia is on board or not. if anesthesia is not yet started they use 73 and get 50% reimbursement and if it is started the 74 gets 100%. It has to do with the amount of resources used. And for physicians it does not matter wheter anesthiesia is started or not.

    Debra A. Mitchell, MSPH, CPC-H

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