Example...One of your patients became unstable during a surgical procedure so the physician made the decision to cancel the surgery. The practice went ahead and billed the surgical code with modifier 53 to Medicare which paid the claim.
A week later after the patient returned for a follow-up visit, the practice found its visit code denied because it was billed during the global surgical period.
But we didn't even do the procedure! Right? Turns out that does not matter.
If you report the procedure you are now held to the same global day period as if the procedure was completed. That means if you see the patient back in the office, you will not be able to bill the visit, and if you take the patient back to surgery, you will need to consider appending a 58 (staged procedure) modifier.
It is a consequence of the 53 modifier that many practices are not aware of but several carriers adhere to. Usually the reduced payment of the modifier 53 is not worth the global period restrictions.
Additional points to keep in mind:
Do not attach modifier 53 if the surgery is cancelled prior to anesthesia induction and/or surgical preparation in the operating suite.
Do not append the modifier to report elective cancellation of surgery (e.g., if the patient decides at the last minute that he/or she does not want the procedure) or if the surgeon is delayed.
The appropriate time to use the 53 modifier would be in cases when extenuating circumstances, or changes in the patient's condition that threaten his/her well-being, occur (e.g., arrhythmia or hypotensive/hypertensive crisis) after anesthesia has begun.
