tci Medicare Compliance & Reimbursement - 2007 Issue 29

MODIFIERS: Get Straight On Modifiers 52 And 53

Don't forego discontinued-procedure pay due to modifier confusion.When your physician discontinues a procedure, are you certain how to bill for it? If you're wondering when you can bill for stopped procedures--and how to decide between modifiers--you're not alone. In practice, there's enough overlap between modifiers 52 and 53 to cause continued confusion on how to apply them. Read the following guidance to clear the cobwebs on this tricky distinction. Keep 52 For Unplanned Reductions Modifier 52 (Reduced services) applies when "a service or procedure is partially reduced or eliminated at the physician's discretion," according to CPT. You...

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