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Modifier 53 Scenarios

Modifier 53 Scenarios. By: Murriel and Cheryl. Definition of Modifier 53. Discontinued Procedure

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Modifier 53 Scenarios

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  1. Modifier 53 Scenarios By: Murriel and Cheryl

  2. Definition of Modifier 53 • Discontinued Procedure • Used to indicate that the physician or qualified health care professional terminated a surgical or diagnostic procedure due to extenuating circumstances or those that threaten the well being of the patient

  3. Examples of Appropriate Use • Colonoscopy is terminated due to poor prep • Patient has an adverse reaction to anesthesia • Patient’s vital signs begin to fail • Patient is unable to tolerate procedure due to discomfort

  4. Hysteroscopy • CPT Code 58565-Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants • Documented reasons for termination of procedure: • Unable to place Essure after numerous attempts • Discomfort and malfunction of device • Unable to cannulize right fallopian tube

  5. IUD Removal and IUD Insertion • CPT code 58300-Insertion of intrauterine device (IUD) • Documented reasons for termination of procedure: • IUD kept bending • Unable to insert Mirena • Patient unable to tolerate procedure • CPT code 58301-Removal of intrauterine device (IUD) • Documented reasons for termination of procedure • Patient felt faint and lightheaded • Strings not visible

  6. Colonoscopy • HCPCS code G0121-Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk • Documented reasons for termination of procedure: • Stricture/fixation of transverse colon • Technically difficult, complex, significant looping • Multiple diverticula • CPT code 45385-Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique • Documented reasons for termination of procedure: • Discomfort

  7. Colonoscopy continued… • CPT code 45378-Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) • Documented reasons for termination of procedure: • Poor prep • Redundant colon • CPT code 45380-Colonoscopy, flexible; with biopsy, single or multiple • Documented reasons for termination of procedure: • Discomfort • HCPCS code G0105-Colorectal cancer screening; colonoscopy on individual at high risk • Documented reasons for termination of procedure: • Stool in the colon

  8. Cystourethroscopy • CPT code 52000-Cystourethroscopy (separate procedure) • Documented reasons for termination of procedure: • Stricture

  9. Aneurysm Repair • CPT code 35091-Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta involving visceral vessels (mesenteric, celiac, renal) • Documented reasons for termination of procedure: • Patient coded during procedure

  10. Angioplasty • CPT code 92920-Percutaneus transluminal coronary angioplasty; single major coronary artery or branch • Documented reasons for termination of procedure: • Unsuccessful intervention to the LMCA

  11. Computerized Dynamic Posturography • CPT code 92548-Computerized dynamic posturography • Documented reasons for termination of procedure: • Performed, but not completed

  12. Esophagogastroduodenoscopy • CPT code 43235-Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) • Documented reasons for termination of procedure: • Failed esophageal intubation due to abnormal anatomy • Unable to pass scope past pharynx due to narrowing • Retained food • Unable to pass scope • CPT code 43249-Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation or esophagus (less than 30 mm diameter) • Documented reasons for termination of procedure: • Esophageal stricture

  13. Injection • CPT code 62311-Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral (caudal) • Documented reasons for termination of procedure: • Difficulty confirming needle placement • CPT code 64483-Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level • Documented reasons for termination of procedure: • Patient repeatedly moved

  14. Endometrial Biopsy • CPT code 58100-Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure) • Documented reasons for termination of procedure: • Unable to pass dilator into cervix

  15. Insertion of Gastrostomy Tube • CPT code 49440-Insertion of gastrostomy tube, percutaneous, under fluoroscopy guidance including contrast injection(s), image documentation and report • Documented reasons for termination of procedure: • Patient coded during procedure

  16. Echocardiography • CPT code 93320-Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (list separately in addition to codes for echocardiographic imaging); complete • CPT code 93325-Doppler echocardiography color flow velocity mapping (list separately in addition to codes for echocardiography) • CPT code 93351-Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional • Documented reasons for termination of procedure: • Unable to exercise long enough on the treadmill

  17. Insertion of Pacing Electrode • CPT code 33225-Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (list separately in addition to code for primary procedure) • Documented reasons for termination of procedure: • Attempted but not successful

  18. Insertion of Central Venous Catheter • CPT code 36556-Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older • Documented reasons for termination of procedure: • ***Procedure was not discontinued per the documentation

  19. Questions?

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