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.

Resource

 

Last Updated Dec 09 , 2023