Ask Dr. Z

Is modifier -53 appropriate to use in this case since the graft was completed and the patient decompensated upon closing.

"The midline fascia was then closed using a running PDS suture as the bowel was returned to the abdominal cavity. Marked distention was noted, but we were able to get the abdomen almost closed when the patient dropped her pressure again into the 60s and 50s. The abdomen was reopened and noted to be filled with blood. At this point, manual pressure was held on the aorta above the graft, and the aortic clamp was reapplied to the infrarenal aorta just proximal to the anastomosis. The distal clamp was also placed. At this point, the patient was noted to be in electromechanical dissociation, and despite numerous rounds of drugs administered by the anesthesia service, the patient did not return with a pulse."