Wiki Modifier 52 vs 53

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Gator said:
If an endometrial biopsy is discontinued due to stenotic external cervical os would modifier 52 or 53 apply?
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I have always found it easiest to remember which may apply by the following mantra "expected or elected calls for 52; unexpected or due to risk calls for 53." I base this on the CPT definitions of the modifiers.

Modifier 52: “Under certain circumstances a service or procedure is partially reduced or eliminated at the physician’s 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.”

Put another way, modifier 52 applies when a reduction in service occurs by choice (either the provider’s or the patient’s).

Modifier 53: “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. This circumstance may be reported by adding the modifier ‘53’ to the code reported by the physician for the discontinued procedure.”

Modifier 53 might also apply if the provider must stop a procedure due to equipment failure or other extenuating circumstances (for example, the provider injures themselves while performing a procedure or the procedure cannot be performed due to an unforeseen anatomic defect).

So bottom line here is whether the physician knew in advance that there was a stenosis but thought the procedure could be performed anyway and tried to accomplish it. Some will argue that an EMBx does not require anesthesia so modifier -53 could not be used. In many instances no anesthetic is required, but check the documentation to be sure. If none was used, I would report modifier -52.
 
nielynco said:
I have always found it easiest to remember which may apply by the following mantra "expected or elected calls for 52; unexpected or due to risk calls for 53." I base this on the CPT definitions of the modifiers.

Modifier 52: “Under certain circumstances a service or procedure is partially reduced or eliminated at the physician’s 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.”

Put another way, modifier 52 applies when a reduction in service occurs by choice (either the provider’s or the patient’s).

Modifier 53: “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. This circumstance may be reported by adding the modifier ‘53’ to the code reported by the physician for the discontinued procedure.”

Modifier 53 might also apply if the provider must stop a procedure due to equipment failure or other extenuating circumstances (for example, the provider injures themselves while performing a procedure or the procedure cannot be performed due to an unforeseen anatomic defect).

So bottom line here is whether the physician knew in advance that there was a stenosis but thought the procedure could be performed anyway and tried to accomplish it. Some will argue that an EMBx does not require anesthesia so modifier -53 could not be used. In many instances no anesthetic is required, but check the documentation to be sure. If none was used, I would report modifier -52.
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hey ms.nielynco,

this was really helpful. I was also wondering if an ultrasound was done but ultimately couldn't tell viability of the fetus so another different ultrasound was done that we also couldn't still tell viability would these get charged with a 52 or 53?
 
also would you use a 52 or 53 for failed iud removal because strings couldn't be visualized and attempts were made to remove it blindly and now she needs a hysteroscopy done to remove it?
 
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