What are Modifier's 53 and their uses

MODIFIER 53
Modifier 53 Discontinued Procedure: Under certain circumstances, the physician 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.
For hospitalists, I believe most of the time we should be using modifier 53 on our procedures (central line, thoracentesis, paracentesis, lumbar puncture) that are discontinued before completion. Most of the time a procedure is aborted, it will be because of anatomical reasons, medical stability reasons or agitation that prevents a safe completion.  I've read some resources that suggest a failure to complete the test because of anatomical reasons should be coded with modifier 52.  My position, at least for what most types of procedures hospitalists do, is that we are going to discontinue our procedures if we are unsuccessful to completion and further attempts risk harm to the patient.

EXAMPLES WHEN TO USE

•            Use of procedures that are terminated prior to completion.  I provide a special review of colonoscopy due to additional guidance by CMS:
o   Use if a colonoscopy is discontinued due to a poor colon preparation or anatomic variation that prevents completion.  This is specifically described in detail in the Medicare Claims Processing Manual Chapter 12 Section 30.1.B (page 27/231)
§  Incomplete Colonoscopies (Codes 45330 and 45378) An incomplete colonoscopy, e.g., the inability to extend beyond the splenic flexure, is billed and paid using colonoscopy code 45378 with the modifier “ - 53. ” The Medicare physician fee schedule database has specific values for code 45378 - 53. These values are the same as for code 45330, sigmoidoscopy, as failure to extend beyond the splenic flexure means that a sigmoidoscopy rather than a colonoscopy has been performed. However, code 45378 - 53 should be used when an incomplete colonoscopy has been done because other MPFSDB indicators are different for codes 45378 and 45330.
§  Interrupted covered screening colonoscopies:  Review pages 126 and 127 here from the Medicare Claims Processing Manual Chapter 18.
o   A surgery is aborted because the patient's vitals signs decompensate.
•             Use if the surgery or procedure is discontinued after anesthesia is administered.
•             Use when the procedure is discontinued due to "extenuating circumstances".  Unfortunately, I have not been able to find how this phrase is defined in clinical situations.
I believe this is why this code can be used for most clinical situations where a physician has elected to discontinue a procedure or surgery, especially in hospitalist medicine.
•             Use for the discontinued procedure after induction of anesthesia.
•             Use if equipment malfunction prevents completion of the intended procedure.
•             Use if the procedure is terminated for reasons beyond the physician's control.  This would appear to qualify as an extenuating circumstance.
•             Use when the patient is having a complication of the procedure
•             Use when the patient cannot tolerate the procedure.

EXAMPLES WHEN NOT TO USE

•             Don't use modifier 53 with E/M services.
•             Don't use modifier 53 with time-based codes.
•             Don't use when converting a laparoscopic or endoscopic intervention to an open intervention.
•             Do not use for elective cancellation of a surgery or procedure. 
•             Don't use for discontinued surgeries prior to anesthesia induction or surgical prep.
•             Not for use by ASCs.  They are instructed to use modifiers -73 and -74.  See below.  
    
DOCUMENTATION

•            Provide operative report documenting why and at what point in the procedure it was medically necessary to discontinue. If the procedure was not surgical, provide a statement or report detailing how the procedure that was done differed from usual.
•             Provide the length and amount of procedure completed and the reason for discontinuing the procedure. Medical Coding Training Hyderabad

REIMBURSEMENT

•             Reduce the normal fee by the percentage of the service you did not provide.
•             Ultimately, you're gonna get paid whatever the insurance company says they're going to pay you and you'll have to go through whatever appeals process they have in place for denials or reductions in claims if you want payment for your services.
Other considerations for using modifier 52 and 53
•             From Medicare Claims Processing Manual Chapter 13 page 52/73 on Section 80.1 regarding physician presence for Supervision and Interpretation (S&I codes) and Interventional Radiology:

o   Radiologic supervision and interpretation (S&I) codes are used to describe the personal supervision of the performance of the radiologic portion of a procedure by one or more physicians and the interpretation of the findings. In order to bill for the supervision aspect of the procedure, the physician must be present during its performance. This kind of personal supervision of the performance of the procedure is a service to an individual beneficiary and differs from the type of general supervision of the radiologic procedures performed in a hospital for which FIs pay the costs as physician services to the hospital. The interpretation of the procedure may be performed later by another physician. In situations in which a cardiologist, for example, bills for the supervision (the “S”) of the S &I code, and a radiologist bills for the interpretation (the “I”) of the code, both physicians should use a “ - 52” modifier indicating a reduced service, e.g., only one of supervision and/or interpretation. Payment for the fragmented S&I code is no more than if a single physician furnished both aspects of the procedure.
Location: Ameerpet, Hyderabad, Telangana, India

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