The reduced-services modifier is appropriate because the complete procedure as described in CPT was not carried out. Use -52 for Closed,Then Open Reductions Suppose a patient has a hip dislocation and reports to your orthopedic practice. The orthopedist attempts a closed reduction, hoping to forego surgery for the more conservative treatment. The closed reduction fails, however, and the patient requires an open reduction the next day by the same physician. Can the practice bill for both services? The right to receive reimbursement for a procedure does not rely on its success or failure, so both attempts can be billed, says Donna Watkins, billing coordinator at Hiler Sports Medicine, a two-orthopedist practice outside of Washington, D.C. Because the closed treatment failed, the practice should bill 27250 (Closed treatment of hip dislocation, traumatic; without anesthesia) appended with modifier -52.
The next day, the practice would bill 27253 (Open treatment of hip dislocation, traumatic, without internal fixation) with modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) appended to indicate that the open procedure was related to the closed procedure but that the global period should be effectively "reset" because the closed reduction failed.