Anesthesia Coding Alert

Question: A pain management physician was performing a celiac plexus injection procedure but stopped halfway through due to an acute change in the patient's condition. Can I report the injection since it was not completed?

Texas Subscriber

Answer: You would report 64530 (Injection, anesthetic agent: celiac plexus...) with modifier 53 (Discontinued procedure) appended. You 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 so much as he is forced to do so because of the circumstances.

You might see the following scenarios as a cause to use modifier 53:

1. The patient develops a contraindication and the procedure must be discontinued for patient health reasons

2. The physician (provider) cannot continue the procedure for some reason

3. The equipment is not working properly and the procedure must be cancelled.

Procedures might stop at any time when the anesthesiologist or surgeon sees some risk that could threaten the patient's health if the case continues. If one of the above reasons does not apply, you should not use modifier 53.

Remember to also report the appropriate ICD-9 code, from the 996.XX��"999.X code range (Complications peculiar to certain specified procedures), explaining to the payer the nature of the complication that necessitated terminating the surgical procedure.

-- Answers to You Be the Coder and Reader Questions were provided by Scott Groudine, MD, an Albany, N.Y., anesthesiologist; and Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.