While going about your anesthesia coding duties, you might encounter various challenges. When your anesthesiologist sees some risk that could threaten the patient's health if the procedure continues, you might turn to modifier 53 (discontinued procedure). Here are some tips to guide you the right way.
Electronic filing challenges
Now in the age of HIPPA and electronic standards, you must first bill electronically. Previously, you may have been told to submit paper claims reporting modifier 53 so you can add a written explanation with the claim. Once you bill electronically with modifier 53, the payer might need more information. If your physician is documenting the right way, the anesthesia note should contain all the information the carrier requires.
Remember: In case you had a failed procedure, the record should state why and what failed. If your physician discontinued the procedure owing to the patient's condition, the record should tell what factors prevented the procedure from going ahead.
You should know when the case was canceled
When you know exactly when the case was cancelled in terms of the anesthesiologist's work will help guide your code choices.
You need to include the right diagnosis
Mention the reason for cancellation by reporting the proper diagnosis code or codes. For instance, a patient experiences syncope while still in the pre-op area before her procedure.
In case a patient experiences syncope while still in the pre-op area before her procedure, you could include diagnosis codes V64.1 and 780.2 on the claim. You may also report the diagnosis for the scheduled procedure depending on when the physician canceled the case.
Electronic filing challenges
Now in the age of HIPPA and electronic standards, you must first bill electronically. Previously, you may have been told to submit paper claims reporting modifier 53 so you can add a written explanation with the claim. Once you bill electronically with modifier 53, the payer might need more information. If your physician is documenting the right way, the anesthesia note should contain all the information the carrier requires.
Remember: In case you had a failed procedure, the record should state why and what failed. If your physician discontinued the procedure owing to the patient's condition, the record should tell what factors prevented the procedure from going ahead.
You should know when the case was canceled
When you know exactly when the case was cancelled in terms of the anesthesiologist's work will help guide your code choices.
You need to include the right diagnosis
Mention the reason for cancellation by reporting the proper diagnosis code or codes. For instance, a patient experiences syncope while still in the pre-op area before her procedure.
In case a patient experiences syncope while still in the pre-op area before her procedure, you could include diagnosis codes V64.1 and 780.2 on the claim. You may also report the diagnosis for the scheduled procedure depending on when the physician canceled the case.
Thank you for the info. It sounds pretty user friendly. I guess I’ll pick one up for fun. thank u
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