Q&A: Don't use modifier -53 for hospital OPPS claims
APCs Weekly Monitor, September 19, 2008
Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor!
QUESTION: My question is regarding a previous Q&A published in the July 18, 2008 APCs Weekly Monitor. The question was about nuclear medicine and modifier -52. In my opinion, the diagnostic procedure was started and then discontinued. The administration of the drug is the start of the procedure because we cannot perform the procedure without the drug. Therefore, the administration of the drug constitutes preparation for the procedure.
I'm curious as to why we shouldn’t append modifier -53 to the procedure if the patient is in the room, we administer the drug, and the exam is cancelled.
ANSWER: Modifier -53 isn’t valid to report under the hospital OPPS. You should use modifier -53 to indicate discontinuation of physician services. It is not approved for reporting outpatient hospital services.
For more information, please see the Medicare Claims Processing Manual, Chapter 4: Part B Hospital, Section 020: Reporting Hospital Outpatient Services Using Healthcare Common Procedure Coding System. View it here: www.cms.hhs.gov/manuals/downloads/clm104c04.pdf
To view the original Q&A, click here.
Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor!
Comments
0 comments on “Q&A: Don't use modifier -53 for hospital OPPS claims ”
Related Products
Most Popular
- Articles
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- Catch up on what's new with injections and infusions
- Identify potential Medicaid RAC target areas
- HIPAA Q&A: Level of encryption needed for email
- Topic: CMS, OESS post new security compliance review information, checklist
- Capturing all necessary codes for IUD insertion and removal can be challenging
- What does case-mix index mean to you?
- OB services: Coding inside and outside of the package
- QA:Coding multiple initial infusions
- E-mailed
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- HIPAA Q&A: Level of encryption needed for email
- Q&A: Follow CMS' coding guidelines when using modifier -25
- What does case-mix index mean to you?
- Catch up on what's new with injections and infusions
- CMS has reformulated payments for some bilateral procedures
- New conflicts of interest create new challenges
- Q/A. One injection code or two?
- ED-to-inpatient transfers are flawed with safety gaps
- Searched