Pain management specialties might make use of modifier 52 as well.
The situation is bound to happen: A patient undergoing surgery has complications, and your anesthesiologist must stop his services. Are you prepared to recognize a situation that calls for modifier 53 (Discontinued procedure) or even modifier 52 (Reduced services)? Learn the specific criteria for reporting each modifier to ensure successful coding every time.
Patient Status Often Determines 53 Use
You will use modifier 53 when a procedure ends due to a threat to the patient’s well-being or other extenuating circumstances. For example, the surgeon performs a preop assessment, but during the evaluation he detects a carotid bruit (785.9, Other symptoms involving cardiovascular system), so he delays the surgery indefinitely until a better evaluation can be made.
Documentation clue: You can only use modifier 53 after anesthesia administration and/or a surgical preparation took place, and the procedure was actually started. You should consider the procedure discontinued when anesthesia ends early. “If any modifier is to be used, 53 is the most appropriate,” says Scott Groudine, MD, professor of anesthesiology at Albany Medical Center in New York.
Example: A patient is being prepared for a routine surgery but has not yet been induced. Another patient develops chest pains and must be induced for surgery immediately, so your anesthesiologist must cancel the first procedure to attend to the second patient’s procedure. You should report 01999 (Unlisted anesthesia procedure[s]) with modifier 53, Groudine recommends.
You should let the payer reduce the fee on services to which you attach modifier 53. Otherwise, you risk additional payment reductions.
Bottom line: When reading the operative report of a discontinued service, simply look at the reason for the discontinuance. If it indicates an extenuating circumstance occurred, use modifier 53.
Facility difference: If you are coding only for facility payment, such as for an ambulatory surgical center (ASC),use modifiers 73 (Discontinued outpatient procedure prior to anesthesia administration) or 74 (Discontinued outpatient procedure after anesthesia administration) instead of modifier 53.
Turn to 52 for ‘Physician Discretion’
Although modifier 52 may not apply to anesthesia, it might apply to pain management specialists. Find out when you should use modifier 52 for your pain management specialist by subscribing to the Anesthesia & Pain Management Coding Alert.
Editor: Joshua Thines
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