Modifier 53 - Know when to Append

If you want to craft a career in medical coding, you have to master not just the codes but also get a grip on ways to append modifiers.

Here are a few tips on ways to handle your modifiers right.

You expected things to proceed normally when a file came to you for coding, but now you realize that things did not go as you had planned it to be. Do you report the case, or was the extent of your doctor’s work covered by pre-op care?

Do you append modifiers 53 (discontinued procedure) or just submit the appropriate surgical or anesthesia code? Here are some tips on ways to handle these scenarios correctly every time.

If you are considering to report modifier 53, keeping a few things in mind will certainly help.

When a physician stops a procedure due to extenuating circumstances or those that threaten the well-being of the patient, you should go for modifier 53, which describes an unexpected problem, beyond the physician’s or patient’s control that require sending the procedure. The physician does not choose to discontinue the procedure as much as he is forced to do because of circumstances.

Modifier 53 is for services that are discontinued for very specific reasons. Here are three things you must watch out for:

• The patient develops a contraindication and the procedure must be discontinued because of patient health reasons

• The physician can’t carry on with the procedure owing to some reason

• The equipment isn’t functioning right and the procedure must be cancelled

You should make use of modifier 53 if one of these reasons does not apply. The only exception might be that Medicare wants modifier 53 for a patient who is prepped to have a colonoscopy but the prep is not adequate and hence the patient must be re-prepped and the colonoscopy done at a later time.

And what if the above situations do not apply to your case? Although non-Medicare payers can make their own rules, most would lead you to go for modifier 52 instead of 53.