Health Information Management

Q&A: Don't use modifier -53 for hospital OPPS claims

APCs Insider, September 19, 2008

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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.



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