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.
This circumstance may be reported by adding CPT Modifier 53 to the code for the discontinued procedure.
This modifier is not used to report the elective cancellation of a procedure prior to the inducing anesthesia and/or surgical preparation in the operating suite.
According to the Centers for Medicare & Medicaid Services (CMS) and CPT coding guidelines, modifier 53 should be used with surgical codes or medical diagnostic codes.
Inappropriate Usage Of Modifier 53
Don’t use the 53 modifier with:
Evaluation and management (E/M) services
Elective cancellation of a procedure prior to the patient’s anesthesia induction and/or surgical preparation in the operating suite
When a laparoscopic or endoscopic procedure is converted to an open procedure or when a procedure is changed or converted to a more extensive procedure.
It is not appropriate to use modifier 53 if a portion of the intended procedure was completed and a code exists which represents the completed portion of the intended procedure.
Reimbursement For Modifier 53
Providers may asked to submit Medical records and the payer reviews the claim and operative report, looking specifically for dictation which supports or identifies the extenuating circumstances that threaten the well-being of the patient that required the procedure to be discontinued.
Reimbursement of discontinued procedures with CPT modifier 53 is 25 to 30 percent of the allowable amount for the primary unmodified procedure. Multiple procedure reductions will still apply.