Cardiology Coding Alert

Question: What guidelines should I adhere to for a surgery cancelled midway through for health reasons? I’ve been debating between modifiers 52 and 53.

Alabama Subscriber

Answer: You may use modifier 52 (Reduced Services) in a variety of contexts. For instance, it can be appended to an ancillary service code, such as radiological imaging. Furthermore, it’s often appended to surgical codes that are inherently bilateral but performed unilaterally. Modifier 53 (Discontinued procedure) is the correct modifier to report for terminated surgeries “due to extenuating circumstances or those that threaten the wellbeing of the patient,” according to the CPT® manual. This example warrants the use of modifier 53.

According to Appendix A in the CPT^® manual, modifier 53 “is not used to report the elective cancellation of a procedure prior to the patient’s anesthesia induction and/or surgical preparation in the operating suite.” This means, when reporting physician services, you may not bill for the surgical service in any capacity if the procedure is terminated prior to anesthesia.