We identified claims reporting modifier 53 (discontinued procedure) without supporting documentation or an explanation in the narrative of the claim.
In order to help you avoid claim denials and future appeals due to incorrect submissions, we are providing guidance on how to properly submit a claim when applying this modifier.
Under certain circumstances, the provider may elect to terminate a surgical or diagnostic procedure due to circumstances that may threaten the well-being of the patient.
Example: Stopped early due to inability to pass the pipelle through the cervix.
Unusual (discontinued) circumstances.
A discontinued procedure after induction of anesthesia.
Append modifier to the discontinued procedure’s CPT code.
To report the elective cancellation of a procedure
Reporting on an evaluation and management (E/M) procedure code
Procedure discontinued prior to the anesthesia being induced:
Do not use on time-based procedure codes (i.e., anesthesia, critical care and psychotherapy)
Used for services in an ambulatory surgery center or a hospital outpatient department
Additional information to support the modifier can be written in the narrative of claim
Supporting documentation should:
State when the procedure was started.
Explain why the procedure was discontinued.
Notate the percentage of the procedure that was performed.
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