tci Part B Insider - 2004 Issue 27

Part B Coding Coach: Do You Know the Difference Between Modifiers -52 and -53?

Hint: Uncovering why the physician halted the procedure is the key to defining reduced servicesIf you're using modifiers -52 and -53 interchangeably, you're making a big mistake. These two modifiers indicate very different reasons for a less-than-total service, and coders can make the correct choice by asking themselves, "Why did the physician stop the procedure?" If Planned or Electively Reduced, Choose -52 When 1) the surgeon plans or expects a reduction in the service, or 2) the surgeon electively cancels the procedure prior to completion, you should append modifier -52 to the appropriate CPT code. Modifier -52 (Reduced...

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