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Modifier 52/53

  1. #1
    Default Modifier 52/53
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    I was wondering if anyone could answer this please. I was under the impression that these 2 codes were for procedures/surg that was discontinued or cancelled. My supervisor thought we could use them when we are billing 99173/92551 if we are unable to complete the test because of pt compliance. Does anyone know if this is true? I thought these modifiers were used mostly for surgical procedures. Thanks alot!

  2. #2
    Columbia, MO
    53 is for a procedure that has been cancelled, after the patient is in the room where the procedure is to be performed.
    52 is a reduced procedure for a procedure where only a portion of the procedure is accomplished and no other code exists for the portion accomplished.
    These are not restricted to surgical codes, that is just where we see them used most often.
    So the difference is if you have a part of the procedure the physician can report findings or results on yet the entire procedure cannot be accomplished the report with a 52, if you cannot get any part of the procedure accomplished then report with a 53.
    If you use a 53 modifier then you will need a secondary dx code from the V64.x category.

    Debra A. Mitchell, MSPH, CPC-H

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