Wiki Failed Procedure In Office

[abrookner232@gmail.com]

Hello,

If a provider attempts a procedure (ex: pessary insertion) in office, but the procedure fails, can they still report the procedure with the E/M? Does it need modifier 53 or can it be billed without a modifier since the entire procedure was performed?

 

[csperoni]

If the procedure fails, it was not fully completed. -53 is most likely the best choice. Sometimes with failed procedures, the clinician is doing the same or similar work as if the procedure was successful. But if the procedure was not completed, -53 is appropriate.

 

[abrookner232@gmail.com]

Just to understand, if the clinician is doing the same work as if the procedure was successful, why would modifier 53 be reported? The procedure was completed but not successful, the provider did not document they had to stop at any point.

 

[csperoni]

Perhaps I'm misunderstanding and a better explanation of your specific scenario that the procedure was "completed but not successful" could be helpful. In gyn, an example of -53 being appropriate would be:
58100-53 for attempted endometrial biopsy. Patient has cervical stenosis and provider attempts 3x to get an endometrial biopsy, but was unable to sample the endometrium. The provider actually spent more time than doing an endometrial biopsy, but was not able to complete the procedure so -53 is appropriate.