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Policy No:  102

Originally Created: 10/01/2008

Section:  Modifiers

Last Reviewed: 03/01/2019

Last Revised: 03/01/2019

Approved: 03/07/2019

Effective: 04/01/2019

This policy applies only to physicians and other qualified health care professionals.

Definitions

Modifier 53 - Discontinued Procedure

Current Procedural Terminology (CPT®) modifier 53 is used due to certain situations when a physician or other qualified health care professional elects to terminate a surgical or medical diagnostic procedure due to extenuating circumstances when the well-being of the patient is at risk. The surgical or medical diagnostic procedure is discontinued.

Policy statement

CPT modifier 53 is valid only when a physician or other qualified health care professional elects to terminate a surgical or diagnostic procedure due to extenuating circumstances that threaten the well-being of the patient.

CPT modifier 53 should be appended to only one code per operative session. Procedure codes for other procedures not performed at all should not be additionally reported.

CPT modifier 53 is not valid when used for elective cancellation of a procedure prior to anesthesia induction and/or surgical preparation in the operating suite.

CPT modifier 53 is not valid when a laparoscopic or endoscopic procedure is converted to an open procedure or when a procedure is changed or converted to a more extensive procedure. The open procedure or a more extensive procedure should be reported.

CPT modifier 53 indicates procedure discontinued by physician or other qualified health care professional and may not be reported by facilities.

Reimbursement for discontinued procedure with modifier 53 is 25% of the allowable amount. The reduction to 25% of the allowable amount will apply when modifier 53 is billed with other pricing modifiers, for example, a discontinued procedure performed by an assistant surgeon.

The fee reduction applies to procedure codes including anesthesia codes. The fee reduction does not apply to codes with unique Relative Value Units (RVUs) for the modifier 53 combination, such as 44388-53, 45378-53, G0105-53 and G0121-53.

For outpatient hospital or Ambulatory Surgery Center (ASC) reporting of a discontinued services, see modifier 73 and 74.

References

American Medical Association. "Appendix A – Modifiers."  Current Procedural Terminology (CPT). Chicago: AMA Press.

Centers for Medicare & Medicaid Services (CMS), Chapter 4, section 20.6.4 Medicare Claims Processing Manual: Part B Hospitals

Centers for Medicare & Medicaid Services (CMS), Chapter 12, Section 30.1, subsection B Medicare Claims Processing Manual

Centers for Medicare & Medicaid Services (CMS), National Physician Fee Schedule Relative Value File

Centers for Medicare & Medicaid Services (CMS), Medicare Learning Network (MLN) Matters: MM 9317

Cross References

Modifiers 73 and 74; Discontinued Services

Modifiers 80, 81, 82 and AS; Assistant at Surgery

Disclaimer

Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.