Tag Archives: modifier 53
Oncology Coding: Determine the Proper Adverse Reaction Code
Posted on 03. Jun, 2010 by Editor.
Remember to describe all the circumstances surrounding a push to get full reimbursement.
Question: If a non-Hodgkin’s lymphoma patient has an adverse reaction to Rituximab less than 15 minutes into the ordered hour-long infusion, should I report a push?
Answer: Experts suggest the most appropriate way to report a discontinued infusion is to append modifier 53 (Discontinued procedure) to the appropriate chemotherapy infusion code, such as 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug).
You should use modifier 53 when a physician stops a procedure “due to extenuating circumstances or those that threaten the well-being of the patient,” according to CPT.
Modifier 53 describes an unexpected problem, beyond the physician’s or patient’s control, that necessitates ending the procedure. The physician doesn’t elect to discontinue the procedure as much as he is forced to do so because of the circumstances.
Push: CPT guidelines include
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Employ Modifier 53 For Discontinued Anesthesia Services
Posted on 09. May, 2010 by Editor.
Pain management specialties might make use of modifier 52 as well.
The situation is bound to happen: A patient undergoing surgery has complications, and your anesthesiologist must stop his services. Are you prepared to recognize a situation that calls for modifier 53 (Discontinued procedure) or even modifier 52 (Reduced services)? Learn the specific criteria for reporting each modifier to ensure successful coding every time.
Patient Status Often Determines 53 Use
You will use modifier 53 when a procedure ends due to a threat to the patient’s well-being or other extenuating circumstances. For example, the surgeon performs a preop assessment, but during the evaluation he detects a carotid bruit (785.9, Other symptoms involving cardiovascular system), so he delays the surgery indefinitely until a better evaluation can be made.
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Don’t Let Money Go Down the Drain Due to Modifier 52, 53 Confusion
Posted on 07. Apr, 2010 by Editor.
Anesthesia, patient well-being can clue you in to the best modifier choice.
When your urologist ends a procedure early, you know you need to append a modifier to the procedure code, but the challenge is deciding between modifier 52 or 53. Learn the very specific criteria for reporting each modifier to ensure successful coding every time.
Turn to 52 for ‘Physician Discretion’
You should use modifier 52 when your urologist, while performing a service or procedure, chooses to partially reduce or eliminate a portion of the code’s requirements.
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IUD Insertion a No-Go: Which Modifier Do I Use?
Posted on 10. Sep, 2009 by Editor.
Question: My ob-gyn tried to place an IUD, but the patient had a stenotic cervix. The physician could not place the device. What modifier should I use?
Answer: The answer depends on whose advice your payer follows.
According to the American Academy of Obstetricians and Gynecologists (ACOG), you should report 58300 (Insertion of intrauterine device [IUD]) and attach modifier 53 (Discontinued service). The ob-gyn started but discontinued the service, and your practice should be able to receive partial payment for this work.
Opponents of this method point out that CPT’s definition of modifier 53 states, “due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued.” CPT’s definition indicates that the physician must also have performed the surgical prep and anesthesia induction prior to discontinuing the procedure. Note that not every patient requires a local anesthetic for the IUD insertion. Also, CPT Assistant December 1996 explains you should use modifier 53 when a patient experiences an unexpected response or life-threatening condition that causes the procedure to be terminated (such as the patient fainting or developing an arrhythmia). In other words, you shouldn’t append modifier 53 to report elective cancellation.
So what’s your alternative? Suppose your ob-gyn had applied a local anesthetic to the cervix prior to the insertion. If the ob-gyn could not place the IUD because the patient has a stenotic cervix, you should consider this a failed procedure. Therefore, experts say you should use modifier 52 (Reduced services).
Click here to see the agenda for the Ob-Gyn Specialty Coding & Billing Conference in Orlando.
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Capsule Endoscopy Gone Awry: 91110-What?
Posted on 01. Jun, 2009 by Editor.
Question: Our patient came in for a capsule endoscopy, but the capsule got stuck in food on hour five and visuals could not be seen past the stomach. We’ll have to repeat this to see if we can see the small and large intestine. How should we code this procedure?
Answer: If your physician is going to repeat the procedure, append modifier 53 (Discontinued procedure) to 91110 (Gastrointestinal tract imaging, intraluminal [e.g., capsule endoscopy], esophagus through ileum, with physician interpretation and report).
Another option: If you weren’t going to repeat the procedure, you could append modifier 52 (Reduced services) to reflect that the capsule imaged the patient’s anatomy until it became lodged in the food.
Whose equipment? For 91110, make sure your place of service is where the capsule’s data was downloaded. If your practice owns the equipment and capsule (and not a facility), check that your place of service was the office (POS code 11).
If a facility provided the capsule, then append modifier 26 (Professional component) to 91110 — you can code only for the professional component of the service. The facility will also code 91110 and append modifier TC (Technical component).
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Incomplete Screening Colonoscopy: Modifier 52 or 53?
Posted on 31. Mar, 2009 by Editor.
The answer depends on your payer, writes Jenny Berkshire in the April edition of the AAPC’s Coding Edge.
Sometimes screening colonscopies are attempted, but not completed–usually because the patient has been poorly prepped.
When billing Medicare, use Modifier 53 (Discontinued procedure). For private payers following CPT guidelines, use Modifier 52 (Reduced services), Berkshire recommends.
AUDIO: Why the OIG has colonoscopies on its 2009 Workplan – and what this means for you, with Jill Young.
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Mind Your Modifiers When Your Surgeon Works With Others
Posted on 16. Feb, 2009 by Editor.
Automatically appending modifier 52 could be costing you hundreds.
When your surgeon works with another physician during a procedure, you can face major coding challenges. If you don’t coordinate your coding with the other physician’s coder, both doctors could lose money and face audits.
Learn how to correctly code for these shared procedures with this real-world case study.
AUDIO CD: Two-fers! How to get paid for co-surgery and surgical assistance.
Review the Surgical Case
Scenario: A urologist and a general surgeon performed surgery on a patient. The urologist did the orchiopexy and performed the opening and closing. The general surgeon performed an inguinal hernia repair.
Coding dilemma: Which codes should each physician report, and what modifiers should the coders use,
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