tci ED Coding & Reimbursement Alert - 2002 Issue 6

Modifiers Unraveled: Use Modifiers -52,-53 to Indicate Incomplete Procedure

When a procedure is terminated due to patient intolerance or anatomical variance, the CPT Codes that normally would be reported seems inaccurate because it reflects completing the entire procedure. Instead, ED coders should append the procedure codes with either modifier -52 (Reduced services) or -53 (Discontinued procedure) to indicate that only a portion of the procedure was performed. Modifier -53:Well-Being of Patient Threatened According to the AMA, when an ED physician stops a procedure because the patient is not tolerating it, coders should use modifier -53. CPT 2002 states physicians may terminate surgical or diagnostic procedures: "Due to extenuating...

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