Neurology & Pain Management Coding Alert

Question: If a procedure such as an EEG, EMG, MRI, etc. is discontinued due to lack of patient cooperation, can the service be billed with the -52 modifier? For example, all the prep work is performed and all necessary supplies are used, but the patient refuses to continue and the test is half finished.

California Subscriber

Answer: Depending upon the exact circumstances, modifiers -52 or -53 may be appropriate.

Modifier -52 (reduced services) states, Under certain circumstances a service or procedure is partially reduced or eliminated at the physicians discretion. This is usually for services that were started (eg, all the prep work was performed and the test partially completed) but stopped because a patient left against medical advice.
Modifier -53 (discontinued procedure) may also be considered based on the documented details. The definition states, Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well-being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued.

The scenario you describe is discontinued due to lack of patient cooperation. Possibly this was due to fear and anxiety. If the physician deemed this as affecting the patients well-being and stopped the procedure for that reason, it would be more appropriate to use the -53.