Reader Questions:
Consider Protocol Over Modifier -53
Published on Sun Sep 19, 2004
Question: A 4-year-old boy presented to the ED with a lacerated foot. The physician administered conscious sedation, but the patient developed hypoxia, so the doctor never sutured the wound. Should I report the suturing with modifier -53 and administration of conscious sedation with no modifier?
Ohio Subscriber Answer: Although technically you might be able to bill the suture code with modifier -53 (Discontinued procedure) along with the conscious sedation, most ED physician groups would not. Instead, you should bill the appropriate emergency department evaluation and management service (99281-99285) along with the conscious sedation code.
CPT instructs use of modifier -53 when the physician terminates a procedure because of circumstances that threaten the well-being of the patient (after induction of anesthesia and or surgical preparation). In this scenario, the physician has administered conscious sedation, but the developing hypoxia prevents completion of the repair.
