Oncology & Hematology Coding Alert

Question: What guidelines should I adhere to for a surgery cancelled midway because of health reasons? I’ve been debating between modifiers 52 and 53.

North Carolina Subscriber

Answer: You may use modifier 52 (Reduced services) in a variety of contexts. For instance, it can be appended to an ancillary service code, such as radiological imaging. Furthermore, it’s often appended to surgical codes that are inherently bilateral but performed unilaterally. Modifier 53 (Discontinued procedure) is the correct modifier to report for terminated surgeries “due to extenuating circumstances or those that threaten the wellbeing of the patient,” according to the CPT^® code book. If something described in the surgical code was not accomplished, you can use the modifier 52. If the patient’s condition precluded continuing with the procedure, you would apply the modifier 53.

Appendix A of the CPT^® code book further explains that modifier 53 “is not used to report the elective cancellation of

a procedure prior to the patient’s anesthesia induction and/ or surgical preparation in the operating suite.” This means, when reporting physician services, you may not bill for the surgical service in any capacity if the procedure is terminated prior to anesthesia. Billing for the service prior to anesthesia is exclusively reserved for facility billing purposes.