tci Outpatient Facility Coding Alert - 2016 Issue 6

Reader Question: Attempted EGD Can Justify Reporting Modifier 53

Question: The GI attempted an EGD on a patient with primary tongue carcinoma who had multiple therapies including radiation and surgery. The physician failed to advance the scope through the upper esophageal sphincter due to either a radiation stricture or an occlusion. How should I report this procedure? Maine Subscriber Answer: If reporting the professional component,your case warrants the use of modifier 53 (Discontinued procedure). This modifier indicates that a surgical or diagnostic procedure was started but discontinued. Pay attention to the additional note in its descriptor, which states that “This modifier is not used to report...

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