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Modifier 53!!!

  1. #1
    Location
    Jamaica/ Manhattan
    Posts
    39
    Default Modifier 53!!!
    Medical Coding Books
    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
    Location
    Salt Lake city
    Posts
    35
    Default
    Was the physician able to do all 9 procedures? If not you can't bill for them even though they were scheduled. I would just bill for what he was able to do and add mod 53 to each procedure if he was not able to fully complete them. I would also send the claim w/op notes. Same with the assist charges. I have never had this situation happen before so this is just my opinion hope it helps.

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default Answered in Modifier forum
    Duplicate post ... I answered in the Modifiers forum.

  4. #4
    Location
    Jamaica/ Manhattan
    Posts
    39
    Default
    Where can I find any written guidelines on this modifier?

    The doctor did not start the surgery

  5. #5
    Location
    Salt Lake city
    Posts
    35
    Default
    Look in the CPT book apendix A it gives a good descrition about mod 53. If the Dr. did not do anything on the patient no incisions or exams then I don't think you can bill for anything.

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