On certain occasions, providers may have to reduce services or discontinue a procedure for medical reasons. How do providers properly bill in these instances? Providers capture these particular services by appending modifiers 52 or 53 to the applicable claims.
A provider appends modifier 52 to the reduced, original charge to indicate a reduction from the customary procedure. The claim must indicate that documentation is available upon request. By way of example, a provider would append modifier 52 to a CPT indicating a bilateral procedure if only performed unilaterally (and no unilateral code exists).
Relatedly, modifier 53 would be applied if a procedure is discontinued after the induction of anesthesia. In this case, the medical note must state that the procedure was started, why the procedure was discontinued and the percentage of the procedure that was performed. When utilizing modifier 53, the claim must also indicate that documentation is available upon request. Modifier 53 cannot be applied for an elective cancellation of the procedure. By way of example, modifier 53 would be applied is if a colonoscopy is started and then interrupted because of problems with the patient’s self-preparation.
When the 52 or 53 modifiers are appended to a claim, it is important to thoroughly document the services. Please don’t hesitate to contact Precision if you have any questions relating to proper usage of modifiers 52 or 53.