I am desperately looking for feedback regarding modifier 53. Scenario is patient in OR, anesthesia started, procedure READY to begin, but has NOT began, patient developed acute onset ventricular tachycardia requiring a full code, once vitals were reestablished, patient transported from OR to ICU without having planned Total Knee Arthroplasty performed. Is this a modifier 53 procedure?
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Wiki Help-urgent!!!
- Thread starter shellip
- Start date
abringer
New
I believe Modifier 53 is appropriate. If the patient actually makes it to the surgical suite where the procedure is going to be performed this modifier would apply.
mitchellde
True Blue
absolutely this is a txt book example of the 53 modifier usage for the physician coder and 74 modifier for the facility.
THANK YOU!!!!! I did apply the 53 modifier to the CPT, and filed the claim to commercial payer. The insurance adjustor has contacted office stating physician charging for services not performed--fraud. (The EOB shows claim with the 53 modifier applied). I posted the thread seeking validation; even though I researched, having a second opinion in agreement eases the panic moment of second guessing myself. Again, THANK YOU!!!
mitchellde
True Blue
you need to have a procedure note showing the involvement of the physician up to the time it was discontinued, also use a V64 dx code as the secondary dx code along with the medical complication that caused the surgery to be discontinued.
mitchellde
True Blue
possibly did you link it to the procedure? It needs to one of the four codes you link to the procedure regardless of which of the 12 allowed dx codes it is.
mitchellde
True Blue
can you provide an example of how you put the code on the claim, the procedure with dx codes and the linkage
mitchellde
True Blue
ok so you have the dx codes as
A. 715.16
B. 427.5
C. 427.31
D. V58.61
E. V64.3
and you listed then 27447 and linked A
question? did the patient have a cardiac arrest?
also I would have used V64.1 rather than V64.3
The linkage needs to be
27447 53 RT linked to A B C E
A. 715.16
B. 427.5
C. 427.31
D. V58.61
E. V64.3
and you listed then 27447 and linked A
question? did the patient have a cardiac arrest?
also I would have used V64.1 rather than V64.3
The linkage needs to be
27447 53 RT linked to A B C E
Some commercial carriers do not want anesthesia to report modifier 53, at least in Texas. I just found this out a week or two ago.
But first things first, was induction achieved, if yes, then you would bill the CPT code -(ASA) for the procedure planned. In your case I believe you had 27447 along with the ASA code.
The diagnosis for the condition which is the reason for the case being cancelled should be the primary diagnosis code. So, if the patient had V Tach it would be the primary diagnosis code followed by the code for the surgery, 715.96. I believe that is what you had posted.
If anesthesia cancelled the case prior to induction, you can only bill for the anesthesia pre-eval services. This is an E/M code, there is no modifier applied in this case.
But first things first, was induction achieved, if yes, then you would bill the CPT code -(ASA) for the procedure planned. In your case I believe you had 27447 along with the ASA code.
The diagnosis for the condition which is the reason for the case being cancelled should be the primary diagnosis code. So, if the patient had V Tach it would be the primary diagnosis code followed by the code for the surgery, 715.96. I believe that is what you had posted.
If anesthesia cancelled the case prior to induction, you can only bill for the anesthesia pre-eval services. This is an E/M code, there is no modifier applied in this case.
mitchellde
True Blue
This was not posted as an anesthesia case. it was for a surgery cancelled after anesthesia was started.
the Vtach would not be the first-listed dx code for the cancelled procedure, you must use the dx code for the procedure that was planned along with the V64 code to show why the procedure was cancelled and then the code for the V tach.
The poster has the correct codes just the linkage was wrong.