Eli's Rehab Report

Published on Fri Jun 01, 2001 PDF

Question: If an electromyogram (EMG) is discontinued because a patient feels lightheaded, can it be billed with modifier -52? For example, all prep work is performed and necessary supplies used, but the patient refuses to continue and the test is half-finished.

Colorado Subscriber

Answer: Depending on the exact circumstances, modifiers -52 or -53 may be appropriate. Modifier -52 (reduced services) states, Under certain circumstances a service or procedure is partially reduced or eliminated at the physicians discretion. This usually refers to services that were started (e.g., all the prep work was performed and the test partially completed) but stopped because a patient left against medical advice.

Modifier -53 (discontinued procedure) may also be used based on the documented details. The definition states, Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well-being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued.

The case you describe is discontinued because the patient felt sick. Possibly this was due to fear and anxiety. If the physician deemed this as affecting the patients well-being and stopped the procedure for that reason, it would be more appropriate to use -53.