We, at Novitas, have seen 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 Current Procedural Terminology code.
To report the elective cancellation of a procedure.
Procedure discontinued prior to the anesthesia being induced.
When used on E/M services.
For outpatient hospital/ ambulatory surgical center.
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.