Oncology & Hematology Coding Alert

Question: I administered a digital mammogram to a patient, but she could not tolerate the pain and we stopped the procedure before we were able to obtain any good images. Would this warrant appending modifier -52 to the mammography code (G0204)?

Kentucky Subscriber Answer: Modifier -52 (Reduced services) describes a service that you performed but had to partially reduce or eliminate at the physician's discretion. Because you did not obtain any useful images during the mammogram, you should not append modifier -52. This modifier tells the payer that you completed at least part of the procedure, but based on the information provided, this was not the case.

You should instead attach modifier -53 (Discontinued procedure) to G0204 (Diagnostic mammography, producing direct digital image, bilateral, all views). This modifier indicates that the diagnostic or surgical service started, but that the physician discontinued it because of extenuating circumstances or because it threatened the patient's well-being.