tci General Surgery Coding Alert - 2004 Issue 1

Reader Question: Reason for Stopping Differentiates -52 and -53

Question: If one of our surgeons stops in the middle of diagnostic testing, or even a minor procedure, because the patient is uncooperative, may we still bill for the service?Delaware Subscriber Answer: Yes, you may still file a claim, but depending on the exact circumstances, you may have to append either modifier -52 (Reduced services) or -53 (Discontinued procedure) to the appropriate CPT procedure code. Modifier -52 applies when "a service or procedure is partially reduced or eliminated at the physician's discretion," according to Appendix A of CPT ("Modifiers"). You should append modifier -53 if the...

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