IUD Removal

[thressat]

Pt came in for removal of IUD, could not be done because of stenotic os, thinking I will use mod 52 with 58301. Any thoughts?

[FTessaBartels]

Not my area of expertise, but ...

Did the physician begin the procedure and discontinue due to stenotic os?
If so, then I'd use -53 modifier.

I learned that the -52 modifier is for circumstances where the physician completes a procedure that is less than the described procedure, i.e. the plan was to do something less than the full procedure. While the -53 modifier is used when some unforeseen circumstance requires that the procedure be discontinued. I think this more clearly describes the scenario you have given.

However, if the physician didn't get any farther along than examining the patient, then you might only have an E/M code.

F Tessa Bartels, CPC, CPC-E/M

[thressat]

Procedure was actually started and discontinued because of stenotic os. I went with 52 and not 53 because according to the ACOG manuel 53 is only used if the pt undergo's anesthesia induction.

[dmaec]

I agree with FTessaBartels
read the description of 53 again... the part about the anesthesia is for "hospital out patient", in which case you wouldn't use 53, you'd be appending 73 or 74.
{that's my opinion on the posted matter}

[thressat]

Thank you for all of the input.