I was performing avasectomy in the office but had to discontinue the procedure because the patient could not tolerate it. The incision had been made. Should I bill this with the –53 modifier or should I bill an E&M service? The procedure was performed 2 days later in the outpatient surgery center under sedation.
The first procedure should actually be billed with the –52 modifier (Reduced Services), not the –53 (Discontinued Procedure). The –53 modifier should be used if the procedure was discontinued due to extenuating circumstances that threaten the patient’s well-being.
Health Management Brief: Physician Hospital Call Coverage Compensation
Written by Larry A. Kemp, FACHE
Working closely with many practices of all sizes PRS Consulting is acutely aware of key financial pressure points confronting the practice leadership team. Consistently near the top of the list is providing hospital on call coverage duties. This is a multi- faceted issue only magnified with increasing weak margins and soft physician incomes. Pressure points: 1. Receiving little or no payment for providing hospital on call coverage duties and, 2. Financial burdens of rising patient bad debt from growing numbers of uninsured and underinsured patients who receive and follow up care in the practice. Also, Physicians manage on-call responsibilities along with providing direct patient care in the practice and scheduled/unscheduled surgical procedures which are disrupted by physicians conferring with and supporting hospital physicians. Unfortunately, while the number of urology groups receiving on call coverage compensation continues to increase, it is far from uniformed.