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Patient scheduled to have procedure in the ASC. The patient was marked preoperatively in the holding area and our operative plans were reviewed. She was taken to the or and placed supine on the operating room table. Timeout was taken by the surgical team. After an alcohol prep the surgical markings were made. What had been a well defined mobile cyst with visible overlying punctum, was now a diffuse area of swelling which was tender for palpation and with jaw clenching. No mention of anesthesia being administered. Doctor decided not to proceed with procedure and to hold off on surgery. Can we still bill for the doctor with modifier 53 and facility with modifier 73?

SuperCoder Answered Tue 07th of March, 2017 02:43:16 AM

Hi,

Discontinued Procedure: Under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure.

This modifier is 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. For outpatient hospital/ambulatory surgery center (ASC) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for ASC hospital outpatient use.)

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