When a GI decides to discontinue a procedure, do you know what to include in your claim? While you could mistake modifiers 52 and 53 as one or the other because they're both used for incomplete procedures, these two have very distinct functions. Check out this EGD scenario and learn which modifier applies on the following "what-if" situations. Scenario: What-if #1: GI Encounters Life-Threatening Obstruction Suppose that while inserting the endoscope, the patient registers unstable vital signs. The gastroenterologist, then, decides it is not in the patient's best interest to continue the procedure. You would report this on your claim using: Other situations that would call for a discontinued procedure include respiratory distress (786.09), hypoxia (799.02), irregular heart rhythm (427.9), and others usually related to the sedation medications. Modifier 53 Defined: In addition, you shouldn't disregard the importance of submitting documentation that shows: What-if #2: GI Calls Off the Procedure for Other Specific Reason Taking on the same scenario, the gastroenterologist begins the diagnostic EGD but stopped without examining the entire upper gastrointestinal tract because she encounters an obstructing lesion in the middle of the stomach. In this case, you should attach modifier 52 to the CPT, says Margaret Lamb, RHIT, CPC, of Great Falls Clinic in Great Falls, Mont. Modifier 52 Defined: Other factors from which your gastroenterologist might opt for a reduced service include: Reminder: Offices' policies vary on whether to reduce physician fees when submitting modifier 52 or 53. While some physicians will reduce submitted fees indicating that the procedure was not completed, others will stick to their regular rates. However, the insurance company always has the last say, so you must recognize that not all insurers treat modifiers the same way. This way, you can work closely with payer representatives to understand the insurer's approach to modifiers.