Gastroenterology Coding Alert

Rationale: Coders can use modifier -53 when a gastroenterologist stops a procedure "due to extenuating circumstances or those that threaten the well-being of the patient," according to CPT 2005. On the claim, try to include as much documentation as possible about the discontinued EGD.
 
Other modifier -53 opportunities: Here are some other situations in which your gastroenterologist may also have to stop an EGD, says Margaret Lamb, RHIT, CPC, of Great Falls Clinic in Great Falls, Mont.:
 

You must explain the encounter to the payer as accurately as possible and the exact reasons that the gastroenterologist felt it was necessary to stop the EGD.

Use -52 Sparingly ... Very Sparingly

While you won't likely use modifier -53 often, you'll probably use modifier -52 even less. Coders should use modifier -52 when "a service or procedure is partially reduced at the physician's discretion," this year's CPT manual states.
 
Explanation: If, for some reason, the gastroenterologist begins the diagnostic EGD "but does not feel the need to scope the entire upper gastrointestinal tract because the procedure can be accomplished without performing the entire procedure," then you could use modifier -52, Lamb says.
 
If your gastroenterologist begins a diagnostic EGD and decides that he does not need to continue for reasons other than the patient's well-being, you should:
 

Documentation Requirements Similar for Modifiers

Successful modifier -52 claims must include detailed documentation similar to the sort you would submit for a modifier -53 claim.

When reporting the above example, thoroughly explain the encounter to the payer, and be sure to show why the physician decided that finishing the procedure was unnecessary.