Modifiers 53

Modifier 53:  Used for discontinued procedure
Under certain conditions, if the provider decides to stop a surgical or diagnostic procedure due to the extenuating effect of it on the patient, It can be informed by adding modifier 53 with CPT to prevent denials.

When the procedure is discontinued and modifier 53 is not used, then the provider might not be reimbursed for the same procedure later.

Incorrect use:

• Never use modifier 53 for an elective cancellation of the service provided.
• Never use it with an Evaluation and Management Procedure Code.
• Modifier 53 should not be used for ambulatory surgery center procedures.
• Time-based codes (such as for critical care)

Correct use:

• Always use modifier 53  for professional physician services.
• This modifier is used to report a treatment or procedure when the treatment or procedure is discontinued after anesthesia is administered to the patient.
• These modifiers, although not popular in use, can be confusing because there’s no set definition for ‘extenuating circumstances, and if not used correctly, can lead to underpayment or even denials.

Conclusion:

Modifier 53 should be used with utmost care as it can be quite confusing to use as there are always chances of underpayment or denials because there’s no set definition for ‘extenuating circumstances. Using modifier 53, providers can be sure of full reimbursement. Always keep documentation for the future appeals.

Thanks for reading.

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