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

Claim Reduction Fee Example

Provider performs 60% of service, reducing charges and appends modifier 53.

*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

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.1