Modifier 53 | Discontinued Procedure Explained

Modifier 53 describes a discontinued procedure. It is used when a physician begins a procedure and then decides to terminate it since continuing the procedure will threaten the patient’s health.

1. What is modifier 53?

Modifier 53 indicates that a procedure was discontinued due to extenuating circumstances or those threatening the patient’s well-being. It is important to use this modifier to ensure that the insurance claim is processed correctly and to avoid any potential denials or delays in payment.

2. When to use modifier 53?

Modifier 53 should be used when a physician begins a procedure and then decides to terminate it due to unforeseen circumstances threatening the patient’s health.

A physician might discontinue a procedure because of adverse reactions to anesthesia, obstructed airway, cardiac arrest, hemorrhaging, severe hypertension, or hypotension.

It is important to note that modifier 53 should not be used for E/M or other time-based services.

3. Description

The official description of modifier 53 is “discontinued procedure.”

This modifier indicates that a procedure was started but not completed due to extenuating circumstances or those threatening the well-being of the patient.

4. Examples

Examples of procedures that may require modifier 53 include a laparoscopic cholecystectomy converted to open cholecystectomy due to complications, a colonoscopy discontinued due to excessive bleeding, or a cardiac catheterization discontinued to a cardiac arrest.

5. Documentation

When using modifier 53, it is essential to ensure that the provider’s documentation explains why the procedure was discontinued.

This documentation should be submitted with the insurance claim to justify the use of the modifier.

6. Billing

To bill for a discontinued procedure using modifier 53, the procedure code should be reported with modifier 53. The provider should also include documentation explaining why the procedure was discontinued.

7. Common mistakes

One common mistake that medical coders make when using modifier 53 is using it for procedures that are partially reduced or canceled before or after administering anesthesia in an outpatient hospital or ambulatory surgery center. In these cases, modifiers 73 or 74 should be used instead.

Another common mistake is using modifier 52 instead of modifier 53. Modifier 52 should only be used if the provider plans or expects a reduction in services or if the physician electively cancels the procedure.

8. Other modifiers related to modifier 53

Other modifiers related to modifier 53 include modifier 73, which is used to indicate a discontinued outpatient hospital/ambulatory surgery center (ASC) procedure before the administration of anesthesia, and modifier 74, which is used to indicate a discontinued outpatient hospital/ambulatory surgery center (ASC) procedure after administration of anesthesia.

9. Tips

When using modifier 53, it is vital to ensure that the provider’s documentation clearly explains why the procedure was discontinued.

It is also essential to become familiar with the difference between modifier 52 and modifier 53 to ensure the correct modifier is used in each situation.