Modifier 53 Fact Sheet

Definition

  • Indicates the physician elected to terminate a surgical or diagnostic procedure due to the patient's well-being.

Appropriate Usage

  • A discontinued procedure after induction of anesthesia
  • Report modifier 53 in the first modifier field when appended to procedure code 45378, G0105 and G0121
  • Bill modifier 53 with the CPT code for the service furnished

Inappropriate Usage

  • On an Evaluation and Management Procedure Code
  • Discontinued surgeries prior to the anesthesia being induced
  • When appended to an E/M procedure code.
  • Do not use on time based procedure codes. (i.e. critical care and psychotherapy)

Facts

Procedure codes 45378-53, G0105-53, and G0121-53 have their own fee schedule amounts. All other services billed with 53 are subject to carrier medical review and priced by individual consideration.

Supporting documentation should:

  • be available upon request
  • state the procedure was started
  • why the procedure was discontinued
  • state the percentage of the procedure was performed

Example

The physician is reporting that this is a discontinued colonoscopy.

Modifier 53 Sample

Do not report an E/M code with Modifier 53

Modifier 53 Denied

Page Last Updated: Wednesday, 17-Apr-2013 15:04:28 CDT