Wiki Discontinued surgery

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jdibble

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Hi! My surgeon documented that the procedure was cancelled after he had EKG changes following anesthesia induction. He did not document that he did anything else. Is this billable or does he have to actually begin the surgery to bill with the 53 modifier?

Thanks!
 
Modifier 53 is used after the administration of anesthesia. Does not necessarily have to do with an incision being made or not made. The anesthesiologist will be billing for a discontinued procedure. The reason for the discontinuation would be contained in the operative note, which should also have all the other appropriate details to document the session.
 
HReed said:
Modifier 53 is used after the administration of anesthesia. Does not necessarily have to do with an incision being made or not made. The anesthesiologist will be billing for a discontinued procedure. The reason for the discontinuation would be contained in the operative note, which should also have all the other appropriate details to document the session.
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Right, however the question was regarding the surgeon not the anesthesiologist. The facility and anesthesia will have different billing than the surgeon in this case, imo.

What constitutes “start of procedure” per CMS?

Answer: CMS considers surgical incision (or start of procedure if no incision required) as the start time for the procedure.

Old date but still relevant:


In the example above 0% of the surgeon's part was performed.
• Notate the percentage of the procedure that was performed

Documentation required with the claim:
  • A concise statement that explains why it was medically necessary to discontinue the procedure and the length/amount of procedure completed along with any other supporting documentation that the provider deems relevant (e.g., operative report)
 
It was not indicated who the carrier is for the claim. I am in AZ and submit claims to Noridian for Medicare. I have billed modifier -53 under the circumstances in the question. My surgeons have documented their participation in the process of determining whether to continue or not -- even without an incision being made. Never had a problem. Never had a recoup. Record sometimes requested, dependent on carrier. I respectfully disagree.
 
Totally new at this, but would you not use modifier 74 (if the doctor is employed by the hospital and it was an outpatient surgery)?
 
HReed said:
It was not indicated who the carrier is for the claim. I am in AZ and submit claims to Noridian for Medicare. I have billed modifier -53 under the circumstances in the question. My surgeons have documented their participation in the process of determining whether to continue or not -- even without an incision being made. Never had a problem. Never had a recoup. Record sometimes requested, dependent on carrier. I respectfully disagree.
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In the poster's example, there was little to no info. If the report had more documentation (as you describe where they document participation and decision) there would be more justification. I would also want to see the op report to see what was documented and if the patient even made it from the pre-op holding area to the OR or not. Specifically, for orthopedics, I would ask my surgeon if they even wanted to bill for it or not. This was when I worked closely with my surgeons and had direct access to them and was employed by them (not like an outsourced or remote situation where I could not access the providers).

If it were me, I would ask the surgeon what they wanted to do first, if they said they wanted to bill it, their report would have to be much better than what was described in the original post. I think we need more detail.
 
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