Cracking the Code

Coding Modifier 52 versus Modifier 53

Modifier 52, Reduced Services, and Modifier 53, Discontinued Services are similar but very distinct circumstances. Regardless, to utilize either of these modifiers, the documentation will need to show why the provider stopped or otherwise cut a procedure short while they were performing it.

In our CPT Appendix A, Modifier 52 is defined S Reduced services, under certain circumstances service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional, under these circumstances the service provides can be identified by its usual procedure number and the addition of modifier 52, signifying that the services are reduced.

Modifier 53 in our CPT Appendix A is defined as Discontinued Procedure, under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the wellbeing of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. The circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued. Modifier 53 may also apply if the provider must stop a procedure due to equipment failure or other extenuating circumstances (for example, the provider injures themselves while performing the procedure).

So how can you tell if modifier 52 or modifier 53 is most appropriate while coding? Something to remember is modifier 52 applies when a reduction in service occurs by choice (either the provider’s or patient’s).

Key words or phrases to consider modifier 52 would be the use of the word partially, to be reduced, or part of procedure was not completed. Phrases to be considered for the use of modifier 53 would be, procedure stopped before completion, no need to complete procedure.

Q: A surgeon has a patient under anesthesia and fully prepared to proceed with surgery. However, the physician cuts himself and therefore cannot carry out the operation. What modifier is most appropriate?
A: Modifier 53 may be applied to the CPT code to indicate an extenuating circumstance that prevented the procedure from being performed.
Reference: FY 2023 CPT Appendix A, CPT Assist
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