Modifier 53 for Discontinued Anesthesia Service

Pain management (PA) specialties might make use of modifier 52 as well.

This is bound to happen: A patient undergoing surgery has complications; as such, your anesthesiologist must discontinue his services. Are you ready to identify a situation that calls for modifier 53 (discontinued procedure) or even modifier 52 (reduced services)? Take home the specific criteria for using each modifier to have successful coding every time.

Often, patient status determines modifier 53 use

You will report modifier 53 when a procedure concludes owing to a threat to the patient's well-being or other extenuating circumstances. For instance, the surgeon carries out a preop assessment, however during the evaluation he detects a carotid bruit (785.9, Other symptoms involving cardiovascular system); therefore he delays the surgery indefinitely until a better evaluation can be made.

Documentation clue: You can go for modifier 53 after anesthesia administration and/or a surgical preparation took place, and the procedure was actually started. You should think about the procedure discontinued when anesthesia ends early. "If you have to use any modifier, 53 is the most apt," according to Scott Groudine, MD, professor of anesthesiology at Albany Medical Center in New York.

Here's an example: A patient is being readied for a routine surgery; however has not been induced as yet. Another patient develops chest pains and must be induced for surgery very soon; as such your anesthesiologist must cancel the first procedure to attend to the second patient's procedure. Groudine recommends that you should use 01999 (Unlisted anesthesia procedure[s]) with modifier 53.

You should let the payer reduce the fee on services to which you append modifier 53. Or else, you risk additional payment reductions.

Bottom line: While reading the operative report of a discontinued service, just look at the reason for the discontinuance. Report modifier 53 if it indicates an extenuating circumstance occurred.

Facility difference: If you're coding only for facility payment, like an ambulatory surgical center (ASC) report modifiers 73 (Discontinued outpatient procedure prior to anesthesia administration) or 74 (Discontinued outpatient procedure after anesthesia administration) in place of modifier 53.

For ‘Physician Discretion' turn to 52

Although modifier 52 may not apply to anesthesia, it might apply to pain management (PM) specialists.