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Thread: Modifier -53 !!!!

  1. #1
    Join Date
    Apr 2007
    Jamaica/ Manhattan

    Default Modifier -53 !!!!

    AAPC: Back to School
    I have 2 questions regarding this modifier...
    1. if there are 9 scheduled procedures and the surgery is stopped after anesthesia for extenuating circumstances DO ALL 9 CPT CODES ARE BILLED WITH MODIFIER -53 OR JUST THE PRIMARY CPT CODE?

    2. If an assist surgeon is required for the above surgery, could I submit a claim for all 9 CPT CODES FOR THR ASSISTANT SURGEON?

    I couldn't fine any information on CMS or AMA...HELP!!!!

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Had the surgery actually started?

    Had the surgery actually started?

    If NO ... We had a case not too long ago where the patient went into anaphylatic shock after anesthesia administered but before the surgeon had begun to do anything (patient was still being positioned/draped). We did NOT bill anything for surgeon.

    If surgeon had made an incision to begin the procedure, I would code the procedure being started with a -53 modifier. I would not code all 9 procedures.

    Just my take on things. Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Jamaica/ Manhattan


    Where can I find any written guidelines on this modifier?

    The doctor did not start the surgery

  4. #4
    Join Date
    Apr 2007
    Missoula, MT


    from CPT Assistant Archives (4th Quarter 1990 - present) - Copyright American Medical Association 2003
    Hospital Outpatient Reporting Part IV: Use of the CPT Modifiers '52,' '58,' '59,' '73,' '74,' '76,' '77,' '78,' and '91' (September 2003)

    Modifiers for "Discontinued" Procedures

    "These two modifiers are also discussed together to clarify and differentiate usage according to specific CMS policy. Effective January 1, 1999, a new CPT modifier '73,' Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia, replaced modifier '52' to identify discontinued services occurring under the stated circumstances. Before modifier '73,' modifier '53' was used to indicate when a procedure was terminated after the induction of anesthesia (eg, local, regional block(s), or general anesthesia) or after the procedure was started (incision made, intubation started, scope inserted)."

    Also, if the assistant surgeon was never utilized you wouldn't bill for their services either. Hope this is useful.

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