Melissa Posted Fri 31st of January, 2020 11:46:33 AM
Hi, This patient had a colonoscopy that could not get past a mass at the splenic flexure. biopsies were done. later that same day, the patient was taken back to OR for a subtotal colectomy with ileocolic anastomosis by the same physician. Since the colonoscopy has zero global days and the colectomy has 90, would I need a modifier on the colectomy? I am thinking 45385-53 for the colonoscopy and then 44204 for the colectomy later that day...do I need the return to surgery modifier? Thanks
SuperCoder Answered Mon 03rd of February, 2020 08:58:25 AM
Modifier 53 (Discontinued Procedure), can be appended when physician discontinue a procedure when:
- Adverse reaction to anesthesia
- Obstructed airway
- Cardiac arrest
- Severe hypertension or hypotension
The provider’s documentation should explain why he discontinued the procedure. Submit the documentation with the insurance claim to justify using modifier 53.
Since, colonoscope being stuck due to mass at the splenic flexure, then modifier 53 can be appended to the 45385.
On the other hand, there is no need to append return to OR modifier as patient is not under global period. Make sure to provide the proper documentation for the medical necessity and reason of colectomy (44204) on the same day to avoid the possible denial. Also, it is suggested to check the payer specific guidelines for the same, if any.
Hope this helps!