Cheryll Posted Tue 13th of October, 2015 10:22:45 AM
My question is if a pt is scheduled for a PNE which has a 10 day global period, but the procedure is aborted using a mod 53, then pt comes in 3 days later for ov, is pt considered in a global period. My understanding is because pt did not have PNE completed, that pt is not in global for 10 days. I do need clarification for this. Thank you!
SuperCoder Answered Wed 14th of October, 2015 08:42:42 AM
Thanks for your question
Yes, patient is considered in the global period whether the procedure is terminated.
If the procedure is rescheduled and completed within the day global period, the 58 modifier should be added to the procedure code indicating a staged or related procedure. If the procedure is rescheduled after the global window, normal billing codes should be used.
Cheryll Posted Wed 14th of October, 2015 10:02:05 AM
Could you please clarify the question above, What if the pts procedure is aborted before they make an incision would the procedure still be in a 10 day global. In this instance the Doctor inserted a spinal needle, but then aborted the procedure. Would that still be considered a global?
SuperCoder Answered Thu 15th of October, 2015 01:39:54 AM
53—“Discontinued Procedure.” The operative note should describe the extent of the surgery or diagnostic procedure completed and the circumstances that caused the termination.
This modifier is used only for procedures that are started and need to be stopped, for whatever reason.
If the anesthesia given to the patient means the procedure is started. While we are using modifier 53 with CPT code, we will get 50% payment of the procedure whether anesthesia is introduced only.