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.

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 Wed, 17 Oct 2018 12:53:48 +0000