Orthopedic Coding Alert

Question: A knee arthroscopy was stopped early because the patient had an unanticipated infection that threatened the patient’s health. Should I use modifier 52 or modifier 53 to indicate a reduced service?

Pennsylvania Subscriber

Answer: You should use modifier 53 (Discontinued procedure). You’ll use this modifier when providers prematurely end an operation because the patient’s health is at risk.

Alternatively, you’ll use modifier 52 (Reduced services) when an aspect of a code definition is eliminated. For example, when an orthopedic surgeon performs a total hip revision where only the acetabular liner is revised. In this case, the code would be coded as 27137-52 (Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft; Reduced services).

Watch out: A lot of coders want to use modifiers 73 (Discontinued outpatient procedure before anesthesia administration) or 74 (Discontinued outpatient procedure after anesthesia administration) since both indicate a discontinued procedure. You should not use these modifiers, however, because they are facility-reported modifiers. The arthroscopy is a surgery, so stick to the surgeon modifier 53.