Podiatry Coding & Billing Alert

Question: The podiatrist began a screw removal on an in-patient in the hospital - 20680 (Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)). However, the podiatrist had to discontinue the surgery because the patient's health became endangered. What is the correct modifier to append in this situation?

Georgia Subscriber

Answer: The modifier you are thinking of is modifier 53 (Discontinued procedure), which you would append to a diagnostic or surgical procedure when the physician begins a procedure and then decides to terminate it because continuing the procedure threatens the patient's health. So, you would append modifier 53 to the CPT^® code of the procedure that was discontinued- 20680.

Remember, you should never append modifier 53 for:

• An evaluation and management (E/M) code
• Elective cancellation of a procedure before the patient's anesthesia induction and/or surgical preparation in the operating suite
• In an outpatient hospital or Ambulatory Surgical Center (ASC). Note: Instead, in an outpatient hospital or ASC, to report a previously scheduled procedure or service that is partially reduced or canceled as a result of extenuating circumstances or those that threaten the wellbeing of the patient prior to or after adminis­tration of anesthesia, look to modifier 73 (Discontinued out-patient hospital/ambulatory surgery center (ASC) procedure prior to the administration of anesthesia) or modifier 74 (Discontinued out-patient hospital/ambulatory surgery center (ASC) procedure after administration of anesthesia).

Always submit documentation: Submitting modifier 53 alone does not provide the payer with enough information to know how to correctly reimburse the provider. So, make sure you submit the supporting documentation for appending modifier 53. The documentation must state that the physician actually started the procedure, why it was medically necessary for him to discontinue the procedure, and what percentage of the procedure he did perform.

Caution: Make sure you understand the difference between modifier 53 and modifier 52 (Reduced services).

Modifier 53: "Due to extenuating circumstances or those that threaten the wellbeing of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued," according to Appendix A in the CPT^® manual. "This circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure."

Modifier 52: On the other hand, modifier 52 normally applies when the physician plans or expects a reduction in services as represented by the CPT^® code. This reduction of services must occur by choice (by either the physician or patient) rather than necessity (which falls under modifier 53). Reporting modifier 52 tells the payer that the physician completed the procedure, but not the full procedure as indicated by the code descriptor.