Modifier 52 and 53 are CPT modifiers, used with Surgery and Radiology section
CPT codes. Don’t use modifier 52 or 53 with time-based CPT’s
Modifier 52 –
Reduced service/Procedure
Modifier 53 –
Discontinued service/Procedure
Modifier 52 (Reduced procedure)
Append modifier
52 when the procedure was reduced by the physician on his own decision stating
that it’s reduced service.
1. When
there is no CPT code exists to describe the reduced service provided then we
can use modifier 52 with the CPT code which describes the complete procedure.
Eg: CPT 73060 –
Radiological examination of Humerus, minimum of 2 views
If the
physician order and perform single view there is no CPT code for 1 view
Humerus, Hence use CPT with modifier 52 (73060 – 52) as Reduced service.
2. When the physician performed a procedure on one side only but its bilateral CPT Code, then we should append modifier 52.
Eg: CPT 77057 –
Screening mammogram, bilateral (2 view film study of each breast)
If the
physician order and perform right or left side breast screening mammogram, code
it as 77057 – 52
Note: please
make sure there is no other CPT available to describe unilateral procedure then
it’s appropriate to use that code instead of using modifier 52.
3. Any
aborted procedure / attempted procedure but not completed, still we can use
modifier 52.
Eg: PICC – If a
physician attempted for PICC but not able to complete the procedure.
Still we can
use modifier 52 with appropriate CPT.
4. Whenever
we are using only the S&I CPT we have to use modifier 52.
Modifier 52 has
direct impact on reimbursement, it will reduce the payment.
Modifier 53 (Discontinued procedure)
Append modifier
53 to the CPT code stating that the procedure was started but discontinued.
Due to life
threaten situation or other justifying situation of the patient make the physician
to terminate a surgical procedure.
When the procedure was reduced by the physician on his own decision then append modifier
52.
Modifier 53 is
not to be used when the procedure was cancelled prior to the surgical
preparation.
It’s
inappropriate to use modifier 53 when a laparoscopic procedure is converted to
an open procedure.
When multiple
procedures were planned and none of the planned procedures was completed due to
life threaten situation of the patient, Then the first procedure is reported
with modifier 53 and don’t code the other planned procedures.
If one or more
procedures were completed then the completed procedures are reported with
appropriate CPT code and the other procedures that are discontinued are not
qualified for separate reimbursement.
Best Eg:
Colonoscopy, An incomplete colonoscopy would be reported with modifier 53.
Note: ASC (ambulatory surgical center) or outpatient hospital
reporting of a previously scheduled procedure that is partially reduced or
cancelled as a result of justifying circumstances or life threaten situation of
the patient prior to or after administration of anesthesia, Then use modifiers
73 or 74.
Modifier 73(Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC)
Procedure Prior to the Administration of Anesthesia)
Modifier 74 (Discontinued Out-Patient Hospital/Ambulatory Surgery Center
(ASC) Procedure After Administration of Anesthesia)