Wiki Medicare and modifier 53

[Troy1]

We billed cpt code 43235 with modifier 53 and medicare denied saying invalid combination of HCPCS modifier. Not sure what that means. What modifier should we have used?

 

[xXxPARAGONxXx]

We billed cpt code 43235 with modifier 53 and medicare denied saying invalid combination of HCPCS modifier. Not sure what that means. What modifier should we have used?

Please post the procedure report (with PII redacted).

We don't know what happened, so we can't determine how it should be coded.

 

[Cls1530]

Was it inpatient or outpatient? We have a hard time with that modifier being paid in the outpatient setting.

 

[mpurisima]

Can you upload a copy of your report? I don't have issues with Medicare paying our claims with modifier -53. Can you give more information? Place of service? Diagnosis?

 

[amyjph]

https://www.palmettogba.com/palmetto/jmb.nsf/DIDC/8EELF98874~Claims~Modifier%20Lookup#:~:text=CPT%20modifier%2053%20for%20discontinued,procedure%20was%20started%20but%20discontinued.

https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00154901

Was the modifier being used correctly? What is the place of service? Did the claim have the proper documentation and statement submitted on the claim to support the 53?