Aborted or Rescheduled Surgical Procedures:
Optimize Reimbursement Using Modifiers -52 and -53
Published on Tue Aug 01, 2000
Some neurosurgery coders have problems distinguishing between modifiers -52 (reduced services) and -53 (discontinued procedure), in part because their CPT descriptors are similar in many ways. A simple guideline can help coders who choose to use -52 and -53: Modifier
-52 should be attached to codes when the neurosurgeon completed the procedure but did not fulfill all of its requirements, and modifier -53 should be used for procedures that are terminated by the neurosurgeon, typically because of the patients condition.
When to Use Modifier -52
Modifier -52 is not used for an incomplete procedure but rather when the physician completed what he or she set out to do but did so while performing less than all of the complete procedures possible components. If the neurosurgeon, for instance, only performed four of six components of a given procedure, reporting it without a
-52 modifier would be inappropriate, says Barbara Cobuzzi, MBA, CPC, CCS-P, a coding and reimbursement specialist in Lakewood, N.J.
If you dont do exactly what the code describes, you need to inform the carrier that you didnt do it, which is what modifier -52 does, she says.
For example, a patient has a basal cell carcinoma of the scalp that extends down to the skull. If the procedure required limited or partial excision of the outer table of the skull, the neurosurgeon might use 61500-52 (craniectomy; with excision of tumor or other bone lesion of skull), whereas if the tumor invaded full thickness through the skull, code 61500 would be billed without a modifier.
What about procedures that have no established CPT code? In certain situations, instead of using an unlisted procedure code, neurosurgeons may prefer to use the code of a similar, but more encompassing listed procedure and attach modifier -52 to it, Cobuzzi says.
The CPT range for neurosurgery coders does not always offer all the codes needed to describe the services the neurosurgeons perform these days, states Rhonda Petruziello, CPC, reimbursement specialist for Neurosurgery at the Cleveland Clinic Foundation. Modifiers such as -52 can help further enhance or reduce your codes appropriately.
Frequently, informs Petruziello, when we use 64999 (unlisted procedure, nervous system), the carrier will call us to determine the CPT code that comes closest to the procedure performed. A modifier such as -52 appended to the CPT code that best describes the service, will help carriers attach a value to the service where that is not possible when billing for unspecified codes (64999).
Sometimes CPT, Medicare or a private carrier will instruct the provider to use an unlisted code, in which case attaching modifier -52 to a more complex procedure would be inappropriate, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator in North Augusta, [...]
