Orthopedic Coding Alert

Question: In your August 1999 issue of Orthopedic Coding Alert, there is a reader question concerning the coding of an attempted ORIF of an open comminuted articular fracture of the DIP with vascular compromise that was abandoned and amputated. Your response suggested the use of the -22 (unusual procedure services) modifier; however, I am in the understanding that if a procedure is attempted and has to be discontinued because of medical complications that would endanger the patient, modifier -53 would be more appropriate. Please advise if I am misinterpreting the usage for modifier -53.

Angie Ross
Charleston Centers
for Orthopaedic Care, SC

Answer: Modifier -53 (discontinued procedure) indicates when a procedure is completely terminated due to extenuating circumstances or situations that threaten the well-being of the patient.

When a procedure is begun, then it is determined that it will not be effective, for whatever reason, and is then converted to another procedure, then correct coding would be to bill only for the most comprehensive procedure with the -22 modifier, as we indicated. In our example, the attempted ORIF was abandoned and an amputation was performed.