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Gastroenterology Coding Alert

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Modifiers 52, 53: Avoid Costly Mistakes By Making Appropriate Choices

Published on Thu Feb 10, 2011

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: The gastroenterologist performs an esophagogastroduodenoscopy (EGD) to examine the lining of the esophagus, stomach, and upper duodenum of a patient as part of a GERD evaluation.What-if #1: GI Encounters Life-Threatening ObstructionSuppose 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:43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) [...]
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