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 as an attachment. 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

References:

Contact Palmetto GBA JM Part B Medicare

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TDD: 866-830-3188

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