Medical Billing Forum

Coding => Coding => Topic started by: jennifer8055 on March 14, 2014, 09:35:45 AM

Title: modifier 53 vs. modifier 73/74
Post by: jennifer8055 on March 14, 2014, 09:35:45 AM
Does anyone have experience using these for discontinued surgical procedures?  From what I have found, the -53 is for provider and -73/74 is for ASC's/Hospitals only.  One of my doctors has recently had to cancel several patients surgical procedures "day of" or within 24-48 hrs of scheduled surgery.  These have been cancelled due to illicit drug use by the patient that wasn't disclosed by the patient until the hospital does the pre-operative bloodwork/urinalysis and the patient tests positive. 

Can we bill the surgical procedure w/a modifier -53 showing it was discontinued/cancelled even though the patient was not in the operating room, but WAS at the hospital in pre-op, being prepped/worked up for surgery.  That's time that he could have scheduled another patients surgery or been in the office seeing patients, why can't he get reimbursed for it?

I can understand if they were cancelled a couple of days prior, but if it's cancelled day of surgery due to drug use or even the patients blood pressure being too high, shouldn't we be able to bill that?  Thanks in advance for any info !!

Jennifer
Title: Re: modifier 53 vs. modifier 73/74
Post by: Merry on March 14, 2014, 11:02:40 AM
http://wpsmedicare.com/j5macpartb/resources/modifiers/modifier-53.shtml
Patient should be in OR and probably already under anesthesia.  Is not used for cancellations in pre- op.  Think of how many surgeries are cancelled because someone has eaten before surgery or bp too high before surgery.   
Title: Re: modifier 53 vs. modifier 73/74
Post by: DMK on March 14, 2014, 11:03:16 AM
Or shows up sick or with at temperature....
Title: Re: modifier 53 vs. modifier 73/74
Post by: jennifer8055 on March 14, 2014, 11:48:09 AM
thanks y'all.  that's what i was thinking based on what i have found and read.....that the patient has to be on the or table already prepped and ready for surgery.  it's aggravating when these patients do this -- here lately it's happening ALOT.  patients are showing up for surgery and testing positive for cocaine......and then act surprised when their surgery is cancelled......


 ???
Title: Re: modifier 53 vs. modifier 73/74
Post by: Merry on March 15, 2014, 05:09:11 PM
Just curious.  Are all patients tested for drugs before surgery?  Are these patients that have commercial insurance?   Wow.. It's not like you can double book surgery. 
Title: Re: modifier 53 vs. modifier 73/74
Post by: PMRNC on March 16, 2014, 09:35:57 AM
If you think about it you can't code it if it didn't happen, no services rendered. It would be the equivalent of billing a missed/cancelled appt.  Maybe you can bill patient for time wasted. :) :) :)
Title: Re: modifier 53 vs. modifier 73/74
Post by: Michele on March 17, 2014, 04:48:20 PM
  Maybe you can bill patient for time wasted. :) :) :)

That's what I was thinking.  Put up a note or make them sign a form stating they will be personally responsible for $xxx.xx if the surgery must be cancelled do to:

1. illicit drug use
2. alcohol use
3. stupidity
4. all of the above 

JK, You probably could get sued for that note.  It would be discrimination against people with stupidity. 
Title: Re: modifier 53 vs. modifier 73/74
Post by: Merry on March 17, 2014, 04:50:32 PM
Michele.. That was funny.  Thx for the chuckle
Title: Re: modifier 53 vs. modifier 73/74
Post by: Zipper on March 29, 2014, 01:53:07 PM
Hi All!
New here.
Similar question- patient was on the table and ready to go.  Surgery had to be cancelled at this point. 
What should the 53 modifier be attached to?  The procedure that I had planned on performing? 
(I am a surgeon just now trying to learn the ins and outs of billing, so you all are most likely miles ahead of me in your knowledge of this subject matter.)
Title: Re: modifier 53 vs. modifier 73/74
Post by: PMRNC on March 29, 2014, 02:14:50 PM
You would only be able to use modifier 53 if they had underwent the induction of anesthesia, and only if the cancellation was due to the patient's well-being. You would append the modifier to the cpt of the surgical procedure. You might be asked for documentation which should consist of the following:
   
   Procedure that was started or to be started
   Documentation as to why the procedure was discontinued
   Documentation on the percentage of the procedure was performed