53 - JF Part B
Modifier 53
Discontinued Procedure (professional services only)
Instructions
This modifier allows the physician community to state the surgical procedure was discontinued due to extenuating circumstances or a threat to patient well-being.
Correct Use
- Append in first pricing position
- Under certain circumstances, physician may elect to terminate surgical or diagnostic procedure
- Surgical or diagnostic procedure started and discontinued by physician
- Prior to or after anesthesia is administered
- Bill Medicare percentage of service completed (see second example below)
- Medicare Claims Processing System does not automatically reduce payment
Incorrect Use
- Do not use to report elective procedure cancellation, in operating suite, prior to patient's anesthesia induction and/or surgical preparation
- Inappropriate with E/M or anesthesia codes
- Inappropriate to use for Ambulatory Surgery Center (ASC) or hospital facility claims. Use facility modifiers 73 or 74
- Do not confuse with "reduced procedure" modifier 52
Claim Coding Example
Treatment Description | CPT/Modifier |
---|---|
Sigmoidoscopy; flexible; diagnostic | 45330 53 |
Claim Reduction Fee Example
Provider performs 60% of service, reducing charges and appends modifier 53.
Description | Amount |
---|---|
Medicare Physician Fee Schedule (MPFS) Allowed* | $200 |
Bill Reduced Amount ($200 x 60%) | $120 |
*Medicare recognizes that many providers use one standard fee schedule for all insurance carriers. Therefore, reducing the charge amount may differ from the example.
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