tci ED Coding & Reimbursement Alert - 2003 Issue 9

When the Patient Leaves the ED, Don't Leave Out -52 and -53

CompleteYour Claims for Incomplete Procedures Your physician may have to stop treating a patient before she completes the procedure - but don't abort your codes before adding modifier -52 or -53. Coders often misuse modifiers -52 (Reduced services) and -53 (Discontinued procedure), and with good reason. Technically, both modifiers can describe procedures that are cut short, and both can cite the patient's well-being or other extenuating circumstances as reasons for discontinuation. But here's the key: More often than not, modifier -53 indicates a procedure the physician aborted before completion because continuation posed a threat to the patient's health. Modifier...

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