tci General Surgery Coding Alert - 2003 Issue 10

Reader Question: No Incision, No Modifier -53?

Question: Prior to surgery, we established general anesthesia, but the patient began breathing erratically and the surgeon canceled the procedure. The patient was not prepped, and no incision was made. How should we bill this?New Jersey Subscriber Answer: Most Medicare and some private insurers will not recognize a "reduced services" modifier or offer any payment unless you actually prepped the patient and started an incision. Ask your individual carrier for its policy for canceled surgeries. For carriers that do not have such a policy, the surgeon should report the appropriate procedure code appended with modifier -53 (Discontinued procedure)...

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