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Skip to main content. CPT Modifier Reduced Services This modifier is used to report a service or procedure that is partially reduced or eliminated at the physician's election. Submit CPT modifier 52 with the code for the reduced procedure. You may not submit CPT modifier 52 if the procedure is discontinued after administration of anesthesia. Guidelines for claim submission and documentation: Submit the reason for the reduced service in the electronic documentation field or, if you are approved to submit paper claims, in Item By definition, modifier 53 is used to indicate a discontinued procedure and modifier 52 indicates reduced services.
In both the cases, a modifier should be appended to the CPT code that represents the basic service performed during a procedure. Choosing between modifiers 53 and 52 can sometimes be confusing. A wrong modifier can lead to denials. The reason for this confusion is the ambiguity in its definitions. For example, whenever a colonoscopy is performed, it is necessary to determine if the colonoscopy is performed for diagnostic purpose or a therapeutic reason.
While coding, medical documentation should be referred to for specific modifier usage cues. Medical documentation should indicate the part of the colon till the scope could be advanced. Please refer to the diagram below for anatomical positions of important parts of colon. The use of modifier 52 or 53 is based on scheduling a repeat EGD.
CPT Assistant Jan. Question: The descriptor of code reads, "Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling biopsy , single or multiple. Answer: Yes. It would be appropriate to append modifier 52 to code when reporting the removal of all nodes except the internal iliac nodes. Modifier 53 applies if the provider quits a procedure because the patient is at risk.
In other words, the provider does not so much choose to discontinue the procedure, as sound medical practice compels him or her to do so. This circumstance may be reported by adding the modifier 53 to the code reported by the physician for the discontinued procedure. Question: How would phenol injections to the superior hypogastric plexus be reported when, following multiple-needle positioning attempts at the right and left L5 region, the procedure is discontinued due to the patient's increased heart rate and suboptimal dye spread?
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