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53 modifier

  1. #1
    Default 53 modifier
    Medical Coding Books
    I have a questions about 53 modifier use for injections... Our nurse had problems giving an expensive injection last night. Can we bill the 90772 with a 53 modifier and the medication that was 'ruined'? I've searched the CMS website, but was unable to find information to help. Has this happened to anyone? Below is the nurse chart documentation:

    "Pt in office as walk in for Risperdal Consta injection. Blood aspirated upon injection, injection not given. New injection ordered and should be here tomorrow. Will call pt when arrives. MM"

    I will ask her to document more detail as far as the medication used. This is for a Medicaid patient. Please help! Thanks! Susan

  2. #2
    Default Modifier 53
    It's my understanding, that modifier 53, is used for those procedures generally done under anesthesia. In my modifier book "Coding with Modifiers" second edition, it gives the definition as:
    "In certain circumstances, the PHYSICIAN may elect to terminate a surgical or diagnositic 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 patient's anesthesia induction and/or surgical preparation in the operating suite."
    I don't think I would use the 53 modifier in the instance of a nurse giving an injection.

  3. #3
    Go to the website below. This includes the rules on how to bill for unused drugs and biologicals set-forth by CMS. Go to page 5 for the rule.
    adrianne, cpc

  4. #4
    Thanks for your help!

  5. Default
    Consider modifier JW if there was wasted medication.

  6. #6

    One of the recent newsletters from the Coding Institute recently had a very good article on billing for meds wasted/not utilized.

    It gave a link to the info:

    Hope this helps you!
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

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