Ob-Gyn Coding Alert

To correctly apply halted procedure modifiers 52 (Reduced services) and 53 (Discontinued procedure), you need to ask yourself:

- Was the patient's well-being in question?

- Did the ob-gyn not complete the entire procedure?

Take the following modifier challenge by reading the following scenarios. Choose your modifier, and compare your answers with our experts-.

Scenario 1: The ob-gyn attempts to perform an endocervical curettage on a patient with postmenopausal bleeding, but cervical stenosis prevents him from completing the procedure. What modifier should you use -- modifier 52 or modifier 53?

Scenario 2: The ob-gyn attempts to perform the same endocervical curettage as the previous scenario. This time, the patient experiences a heart arrhythmia right after a regional anesthetic has been applied, and the ob-gyn decides not to continue the procedure. What modifier should you use -- modifier 52 or modifier 53

Scenario 1 Answer: You would report 57505 (Endocervical curettage [not done as part of a dilation and curettage]) with modifier 52 linked to 627.1 (Postmenopausal bleeding).

Many coders get tangled up when deciding between modifiers 52 and 53. But the difference doesn't have to stump you, according to Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania Department of Medicine in Philadelphia.

Difference: Modifiers 52 and 53 both describe halted procedures, but they differ in that you use 52 when your ob-gyn performs a reduced service or has not completed all the components of the code description, and modifier 53 when the patient's well-being is in question.

You should use modifier 52 for a failed procedure when the ob-gyn could not complete the originally planned surgery. In other words, the physician elects to reduce or eliminate a portion of a service or procedure. "The physician does not perform all of what's described in the CPT code definition," says Cheryl Ortenzi, CPC-I, billing and compliance manager at BUOB/Gyn in Boston.

Sending a cover letter and op note to the payer may help explain how much physician work is reflected with the reduction or elimination of a portion of the service. In some cases, there will be more work involved when a procedure fails, rather than less.

Scenario 2 Answer: You should report 57505-53 to show that the physician discontinued the surgery because of the patient's condition.

Rationale: In contrast to modifier 52, you should use modifier 53 only when the surgeon stops the entire procedure and takes the patient to recovery because of her condition. "The patient's condition is threatened," Ortenzi adds. No other procedure is done.

This modifier can only be used if the procedure was discontinued after anesthesia was administered and/or the patient was prepped in the operating suite, Smith says.

Heads up: Don't mix up modifiers 52 and 53 with modifiers 73 (Discontinued outpatient procedure prior to anesthesia administration) and 74 (Discontinued outpatient procedure after anesthesia administration). Generally, only hospitals or ambulatory surgery centers use modifiers 73 or 74 for services and procedures performed for outpatients.