tci Part B Insider - 2014 Issue 18

Part B Revenue Booster: Incomplete Service Doesn't Mean Nonexistent Payment

Know the rules for modifiers 52 and 53 to collect your payments despite not completing procedures. Your surgeon performs a total abdominal hysterectomy, but decides not to do the partial vaginectomy. How should you code for this? The answer: Ask why he stopped the procedure. When the physician can’t complete a procedure, many coders are confused about when to use modifier 52 (Reduced services) and when to use modifier 53 (Discontinued procedure). But once you know why the physician decided not to finish the surgery or service, you can readily pick your modifier. Avoid this problem: The key...

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