General Surgery Coding Alert

Question: Prior to surgery, we established general anesthesia, but the patient began breathing erratically and the surgeon canceled the procedure. The patient was not prepped, and no incision was made. How should we bill this?

New Jersey Subscriber

Answer: Most Medicare and some private insurers will not recognize a "reduced services" modifier or offer any payment unless you actually prepped the patient and started an incision. Ask your individual carrier for its policy for canceled surgeries. For carriers that do not have such a policy, the surgeon should report the appropriate procedure code appended with modifier -53 (Discontinued procedure).
   
According to the CPT descriptor for modifier -53, "Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. 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."
  
If the patient's breathing was unstable enough to cancel surgery, the surgeon likely admitted the patient to the hospital. If your payer won't accept modifier -53 for this procedure and the surgeon admitted the patient, you may be able to report a hospital admission code (99221-99223).
  
Note: Modifier -53 is not appropriate to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite.