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General Surgery Coding Alert

Reader Questions:

Turn to 53 for Attempted Procedure

Published on Sun Apr 26, 2009

Question: My surgeon was performing a diagnostic EGD. While inserting the endoscope, he encountered an obstruction. After several attempts to get around the obstruction, the surgeon decided it was in the patients best interest to end the procedure. Can I still report the procedure? Washington Subscriber Answer: You can, and should, still report a procedure that your surgeon has to discontinue for the patients safety and health. In this case, youll need to use modifier 53 (Discontinued procedure) and append it to the diagnostic EGD code. So youll report 43235-53 (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]). Rationale: You can use modifier 53 when your surgeon 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 [...]
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