Indicates the physician elected to terminate a surgical or diagnostic procedure due to the patient's well-being.
First, reviewing the defintion of modifer 53 relays that this modifier represents that a circumstance that could comprise the patient's well being if the physician would attempt to complete the procedure. Typically in Box 19 or electronic corresponding section, you would place the statement: "Documentation available upon request" This will prompt the carrier to review the following:
1. That the procedure was started
2. why the procedure was discontinued
3. the percentage of the procedure was performed
Furthermore, the above source states after induction of anesthesia which makes this modifier sound more for more invasive procedures that would require sedation versus a trigger point injection that could be reschedule at later date and amount resources/time involve in the attempt would not be a concern for accepting not report this encounter.
Below is more on modifier 53 from AMA perspective
Please provide the definition and illustration of Modifier 53.
Following is the definition and illustration ofModifier 53, Discontinued Procedure:
Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance may be reported by adding the modifier 53 to the code reported by the physician for the discontinued procedure. Note: This modifier is not used to report the elective cancellation of a procedure prior to the patientâ€™s anesthesia induction and/or surgical preparation in the operating suite. For outpatient hospital/ambulatory surgery center (ASC) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for ASC hospital outpatient use).
Modifier 53 is used for physician reporting purposes.It is used to report circumstances when patients experience unexpected responses (eg, arrhythmia, hypotensive/ hypertensive crisis) that cause the procedure to be terminated. ASC policy requires documented narrative regarding how far the procedure had progressed at the point of termination.
Modifier 53 differs from 52 (which describes a procedure that was reduced at the physicianâ€™s discretion) in that a patientâ€™s life-threatening condition precipitates the terminated procedure.Modifier 53 is not used to report elective cancellation of procedures prior to anesthesia induction or surgical preparation in the surgical suite, including situations where cancellation is due to patient instability.
For outpatient hospital/ASC facility reporting, refer to modifiers 73 and 74 in the list of ASC-approved modifiers.
Illustration of Modifier 53
Following anesthesia induction, the patient experiences an arrhythmia that causes the procedure to be terminated. The physician reports the code for the planned procedure with the 53 modifier appended.
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