Anesthesia Coding Alert

Don’t get confused by similarities. 

When deciding which modifier applies to a case that didn’t go as planned, be sure you separate modifier 52 (Reduced services) from modifier 53 (Discontinued procedure). 

To apply modifier 52 instead of 53, the reduction of services must occur by choice (either the physician’s or the patient’s) rather than necessity. If your physician determines that the patient requires a service but at a lesser level than the complete code description indicates, or if the patient elects to cancel after the procedure has started but prior to its completion, then modifier 52 is appropriate. You might also turn to modifier 52 when the code specifies a bilateral service but the physician performs the service on only one side.

If the case is cancelled after induction, the patient already may have been given anesthetics and the anesthesia provider will need to reverse the process. “Time will be reduced as a natural outcome and so a -52 modifier doesn’t really apply to the anesthesia service, in my opinion,” says Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla.