Radiology Coding Alert

Question: I am confused about the proper use of modifiers -52 (reduced services) and -53 (discontinued procedure). Could you explain the difference between them?

Anonymous CA Reader

Answer: CPT 1999 defines modifer -52 in this manner: Under certain circumstances a service or procedure is partially reduced or eliminated at the physicians discretion. Under these circumstances the service provided can be identified by its usual procedure number and the addition of the modifier -52, signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service

And modifier -53 is defined: 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

Noting that imaging centers use these modifiers only in the most unusual circumstances, Darlene Zase, BS, CMPE, explains that the difference between -52 and -53 is one of degree. The radiologist may reduce the extent of a diagnostic procedure if it becomes apparent that the patient isnt tolerating it well. Here, a -52 modifier would be appropriate.

Modifier -52 also may be assigned in the referring physician or radiologist decides to limit the study before beginning the procedure.

On the other hand, we would use modifier -53 in more dire circumstancesperhaps the well-being of the patient is threatened and it is medically necessary to discontinue the procedure. This modifier is rarely usedin fact, I have never had occasion to assign it in my experiences, says Zase.

In any of these instances, both modifiers provide a mechanism for the radiology practice to recoup expenses even when procedures are aborted.