Modifier 52, Reduced Services and Modifier 53, Discontinued Procedure apply to physician services while Modifiers 73 and 74, Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia and Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia respectively apply to facility charges. It is important to know that Modifier 53 and Modifiers 73 and 74 are very different. Modifier 53 has the caveat that the procedure was discontinued due to the well-being of the patient after the induction of general anesthesia. Whereas modifiers 73 and 74 have no requirement that the patient’s well being be tied to the procedure’s discontinuance. The surgeon cannot use modifier 53 if the procedure has been discontinued prior to general anesthesia being administered to the patient. And the surgeon cannot use modifier 53 if a procedure that is being performed under local anesthesia has been discontinued, even if it is for the patient’s well-being, for example, because the patient is experiencing more pain than they can bear under a local. The surgeon has fewer options than facilities when it comes to coding and billing for reduced and discontinued services. One of the reasons that the facilities have more latitude with modifiers 73 and 74, for discontinued procedures before and after the administration of anesthesia is because of the costs involved in setting up an operating room.

    Coding and Billing for Facility Services

    From Medicare’s perspective, for services furnished in a hospital outpatient department, anesthesia in Modifiers 73 and 74 is defined to include:

    • Local, regional block(s)
    • Moderate sedation/analgesia (“conscious sedation”)
    • Deep sedation/analgesia and
    • General anesthesia

    When coding and billing for a facility, the 52 modifier is used to indicate a partial reduction or discontinuation of radiology procedures or services that do not require anesthesia. Modifiers 73 and 74 cannot be used to report facility services for discontinued radiology procedures that do not require anesthesia.

    Coding and Billing for Reduced/Discontinued Provider Services

    Modifiers 73 and 74 cannot be used for provider services. They are only valid for facility coding and billing. CMS states that modifier 53is 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.” One way to tell if the service needs a 52 or a 53 would be to consider if the patient had the entire service the physician intended to provide. You also want to make sure that the documentation details the complication(s) that is causing the procedure to be terminated early. These complications can include:

    • Respiratory distress
    • Hypoxia
    • Irregular heart rhythm
    • Issue related to the anesthesia.
    • An equipment failure
    • Extenuating circumstances, such as the physician cut herself

    Use modifier 53 if the surgeon discontinued the procedure without completing the treatment as planned. Use modifier 52 if the service is complete. Although not foolproof, this method is very consistent in identifying which modifier to use. John Verhovshek has a very good blog on provider coding and billing with modifiers 52 and 53 last month. I won’t repeat what is included in that blog, but I will point readers to it  . Found this on CMS: Modifiers -52 and -53 are no longer accepted as modifiers for certain diagnostic and surgical procedures under the hospital outpatient prospective payment system. Coinciding with the addition of the modifiers -73 and -74, modifiers -52 and -53 were revised. Modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service. Modifier -53 is used to indicate discontinuation of physician services and is not approved for use for outpatient hospital services.

    • Author
    • Recent Posts

    Barbara J. Cobuzzi, MBA, CPC, COC, CENTC, CPC-P, CPC-I, CPCO, CMCS, is CEO of CRN Healthcare Solutions and formerly owned a medical billing company. Cobuzzi is a subject matter expert in otolaryngology coding. She provides litigation support as an expert witness for providers and payers and often presents for many local and national organizations. She is also a consulting editor for AAPC’s Otolaryngology Coding Alert newsletter. In 1999, Cobuzzi was named AAPC’s Networker of the Year, and she is a past member of the National Advisory Board. She is one of four founding members of the Monmouth/Ocean, N.J., local chapter and is still active with the chapter.

    About Barbara Cobuzzi Has 100 Posts

    Barbara J. Cobuzzi, MBA, CPC, COC, CENTC, CPC-P, CPC-I, CPCO, CMCS, is CEO of CRN Healthcare Solutions and formerly owned a medical billing company. Cobuzzi is a subject matter expert in otolaryngology coding. She provides litigation support as an expert witness for providers and payers and often presents for many local and national organizations. She is also a consulting editor for AAPC’s Otolaryngology Coding Alert newsletter. In 1999, Cobuzzi was named AAPC’s Networker of the Year, and she is a past member of the National Advisory Board. She is one of four founding members of the Monmouth/Ocean, N.J., local chapter and is still active with the chapter.

    What is the difference between modifier 53 and modifier 74?
    Modifier 53 has the caveat that the procedure was discontinued due to the well-being of the patient after the induction of general anesthesia. Whereas modifiers 73 and 74 have no requirement that the patient's well being be tied to the procedure's discontinuance. more
    How do scholarships and grants differ?
    In general, grants are given based on financial-need, while scholarships are merit-based and awarded to students based on their academic achievements, extracurricular activities, field of study, and more. more
    How does Judaism differ from Catholicism?
    Jews believe in individual and collective participation in an eternal dialogue with God through tradition, rituals, prayers and ethical actions. Christianity generally believes in a Triune God, one person of whom became human. Judaism emphasizes the Oneness of God and rejects the Christian concept of God in human form. more
    Why do NPV and IRR differ?
    Comparing NPV and IRR The NPV method results in a dollar value that a project will produce, while IRR generates the percentage return that the project is expected to create. Purpose. The NPV method focuses on project surpluses, while IRR is focused on the breakeven cash flow level of a project. more
    How does Buddhism differ from Christianity?
    There are inherent and fundamental differences between Buddhism and Christianity, one significant difference being that while Christianity is at its core monotheistic and relies on a God as a Creator, Buddhism is generally non-theistic and rejects the notion of a Creator God which provides divine values for the world. more
    How does cryptocurrency differ from NFT?
    Crypto's fungibility makes it a trusted means of conducting transactions on the blockchain. NFTs are different. Each has a digital signature that makes it impossible for NFTs to be exchanged for or equal to one another (hence, non-fungible). more
    How does Xanax differ from Klonopin?
    Physicians often prescribe Xanax to treat anxiety and panic disorders, but unlike Klonopin, the drug is not used to treat seizures. Because Xanax is relatively fast-acting—individuals can feel the effects within two hours—some people use the drug recreationally to feel a heightened sense of relaxation or sedation. more
    How do grants differ from scholarships?
    In general, grants are given based on financial-need, while scholarships are merit-based and awarded to students based on their academic achievements, extracurricular activities, field of study, and more. more
    Under what circumstances NPV and IRR differ?
    Comparison Chart more
    How does MIRR differ from IRR?
    IRR is the discount amount for investment that corresponds between the initial capital outlay and the present value of predicted cash flows. MIRR is the price in the investment plan that equalises the latest value of the cash inflow to the first cash outflow. more
    How does communism differ from capitalism?
    Capitalism is an economic system in which the trade and industry of the economy is owned and controlled by private individuals, to make profit. Communism refers to social system in which country's trade and industry are controlled by the community and the share of each individual relies on his ability and needs. more

    Source: www.aapc.com

    You may be interested in...

    How do mermaids mate in Siren?

    Do some gas stations water down their gas?

    What country has the best healthcare system?

    Does ADHD increase risk of dementia?

    What Lindo means?

    How can I become a documenter?

    Who makes Schwinn bikes now?

    How much does McDonald's pay in Texas?

    Do apples get rid of garlic breath?

    Is basic salary net or gross?

    Why are my tomatoes so sour?

    Which type of group is not formal group Mcq?

    How quickly can cholesterol be reduced?

    Do grapes help lungs?

    Do banks offer good benefits?

    About Privacy Contact
    ©2022 REPOKIT