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discontinued procedure in office

  1. #1
    Default discontinued procedure in office
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    New Patient had a endometrial biopsy done in conjunction with an office visit (99203) in our Oncology physician office due to Menorrhagia. The physician attempted the biopsy but was unable to complete the procedure. Would you bill the office visit code with mod 25 and the 58100 with a 53 modifier?
    Kristen Richard, CPC

  2. #2
    Default Modifier 53 would be appropriate
    Not enough info to determine if a separate and distinct office visit based on your post, so I can't give an opinion on the 25 modifier. However, if a procedure was started and discontinued modifier 53 appended to the procedure is appropriate. Sounds like the physician actually started the procedure. It is not appropriate to append modifier 53 if the patient is prepped for surgery, anesthesia is given, and the physician never actually begins the procedure.

    ************
    PB

  3. #3
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    The office visit is the main procedure being billed as the physician documented a full o.v. note with all 3 elements in detail and also is utilizing the endometrium CA diag as this patient is a new patient. The physician then began the procedure and aborted due to a complication with dilation. Hope that makes more sense..

    My confusion is with the 53 modifier. It states in the CPT book that it is not used to report the elective cancellation of a procedure prior to the patients anesthesia induction and/or surgical preparation in the operating suite. Does that mean that if a patient is not receiving anesthesia, then this modifier cannot be used. Because that description is confusing. Elective may be the key word here, but I am not sure. This patient was having the procedure done in the office w/o anesthesia. Can this modifier be used due to those circumstances? And if you have had any circumstances like that in your OBGYN office, how would you bill that? Thank you, sorry for the confusion.
    Last edited by krssy70; 01-06-2010 at 07:16 AM.
    Kristen Richard, CPC

  4. #4
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    Quote Originally Posted by krssy70 View Post
    The office visit is the main procedure being billed as the physician documented a full o.v. note with all 3 elements in detail and also is utilizing the endometrium CA diag as this patient is a new patient. The physician then began the procedure and aborted due to a complication with dilation. Hope that makes more sense..

    My confusion is with the 53 modifier. It states in the CPT book that it is not used to report the elective cancellation of a procedure prior to the patients anesthesia induction and/or surgical preparation in the operating suite. Does that mean that if a patient is not receiving anesthesia, then this modifier cannot be used. Because that description is confusing. Elective may be the key word here, but I am not sure. This patient was having the procedure done in the office w/o anesthesia. Can this modifier be used due to those circumstances? And if you have had any circumstances like that in your OBGYN office, how would you bill that? Thank you, sorry for the confusion.
    I would use modifier -52 for reduced services: "partially reduced or eliminated at the physician's discretion".

    Read the entire definition for -53, as the first part is indicated for procedures performed in the office...the part after the word note is for hospital procedures.

    Hope that helps.
    Lisa Bledsoe, CPC, CPMA

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