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Gastroenterology Coding Alert

Reader Question:

Attempted EGD Means Attaching Modifier 53

Published on Thu Nov 10, 2011

Question: The GI attempted an EGD on a patient with primary tongue carcinoma who had multiple therapies including radiation and surgery. The physician failed to advance the scope through the upper esophageal sphincter due to either a radiation stricture or an occlusion. How should I report this procedure?Maine SubscriberAnswer: Your case warrants the use of modifier 53 (Discontinued procedure). This modifier indicates that a surgical or diagnostic procedure was started but discontinued. Pay attention to the additional note in its descriptor, which states that "This modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite."Bill the procedure with 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) appended by modifier 53.
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