tci ED Coding & Reimbursement Alert - 2004 Issue 10

Reader Questions: Consider Protocol Over Modifier -53

Question: A 4-year-old boy presented to the ED with a lacerated foot. The physician administered conscious sedation, but the patient developed hypoxia, so the doctor never sutured the wound. Should I report the suturing with modifier -53 and administration of conscious sedation with no modifier?    Ohio Subscriber Answer: Although technically you might be able to bill the suture code with modifier -53 (Discontinued procedure) along with the conscious sedation, most ED physician groups would not. Instead, you should bill the appropriate emergency department evaluation and management service (99281-99285) along with the conscious sedation code.  ...

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