CPT codes, descriptions, and other data only are copyright 2008 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.
Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyrighted by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the files unless you read, agree to, and abide by the provisions of the copyright statement.
CPT Modifier 53
Description:
Discontinued procedure
Guidelines/Instructions:
Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance must be reported by adding CPT modifier 53 to the code reported by the physician for the discontinued procedure.
- This modifier must be submitted in the first modifier field
- Note: This modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite
- ASCs may not submit CPT modifier 53. For outpatient hospital/ambulatory surgery center (ASC) reporting of a previously scheduled procedure/service that is partially reduced or canceled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see CPT modifiers 73 and 74.
- Documentation required with the claim:
- A concise statement that explains why it was medically necessary to discontinue the procedure along with any other supporting documentation that the provider deems relevant
- This statement may be entered in the electronic documentation field or submitted via the fax attachment process. Railroad Medicare does not have a fax process. For paper claims, this documentation must be submitted as an attachment to the CMS-1500 claim form.
- Services that are submitted with CPT modifier 53 that do not include a concise statement will be rejected as 'unprocessable' with remark MA130 and must be corrected and resubmitted as new claims
Reference: