Orthopedic Coding Alert

Remember which modifier to use for each type of stopped procedure.

Do the rules surrounding modifiers 52 (Reduced services) and 53 (Discontinued procedure) still have your head spinning? You’re not alone; many a coder has gotten confused where one, or both, of these modifiers is concerned.

Help’s here: To provide some real-world application, we asked Yvonne Dillon, CPC, CEDC, to give us some clinical examples of modifiers 52 and 53 in action.

Here’s what she had to say.

Example 1: Modifier 52

Scenario:

Patient present for follow-up of chronic right knee inflammation and pain due to degenerative joint disease. She has tried conservative measures but to no avail, and is not a candidate for surgical intervention. Surgeon suggests and explains a genicular nerve block to the patient with risks and benefits. Patient has agreed to proceed with the procedure today.

Patient has opted for no anesthesia. She is prepped and draped in the usual sterile manner and right knee is positioned over sterile pillow. Local anesthesia is achieved with bupivacaine injected into right knee. Using fluoroscopy to identify the superolateral and superomedial nerves, methylprednisolone was injected as well as bupivacaine. Patient was bandaged and tolerated procedure well.

Coding

For this encounter, you would report:

• 64454 (Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed) for the injection.
• Modifier 52 appended to 64454 to show that the service was reduced.
• Modifier RT (Right side) appended to 64454 to indicate laterality, if the payer requires it.
• M17.11 (Unilateral primary osteoarthritis, right knee) appended to 64454 to indicate the patient’s condition.

Example 2: Modifier 53

Patient present for arthroscopy meniscus repair of left knee due to complex medial meniscus tear from recent traumatic injury. After discussion of benefits and risks, patient still opted to move forward with procedure.

Patient was brought to operating suite, placed in supine position, anesthesia induced. Patient’s correct side was verified. A nonsterile tourniquet was applied to his thigh. Care was taken to pad the tourniquet well. As the leg was then prepped and draped in usual sterile fashion, patient had sudden increase in blood pressure of 180/98 and his finger-stick blood sugar is 398. After multiple BP and glucose readings, decision was made by surgeon to terminate procedure in the best interest and the well-being of the patient. Patient was sent to recovery and monitored closely and then discharged home.

Coding:

For the above scenario, you would report:

• 29881 (Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed) for the repair.
• Modifier 53 appended to 29881 to show that the surgeon discontinued the procedure.
• Modifier LT (Left side) appended to 29881 to indicate laterality, if the payer requires it.
• S83.232A (Complex tear of medial meniscus, current injury, left knee; initial encounter) appended to 29881 to indicate the patient’s condition.