Pediatric Coding Alert

To Append an Attempt or Not?

Answer: In certain circumstances, pediatricians may find it necessary to alter or discontinue a procedure at the physician's discretion or because of unanticipated risk to the patient. When this occurs, you should use a modifier to inform the payer that a defined service was attempted, but altered by specific circumstances.

You will commonly use two modifiers in these situations. Modifier -52 (Reduced services)indicates that a physician partially reduced or eliminated part of a procedure at his or her discretion, according to CPT Codes 2003, Appendix A. Modifier -53 (Discontinued procedure) identifies a procedure that the doctor terminates due to circumstances that create risk for the patient.

In the situation that you describe, the pediatrician completed the procedure unsuccessfully he didn't obtain a sample. Consequently, you should report 36410* (Venipuncture, child over age 3 years or adult, necessitating physician's skill [separate procedure], for diagnostic or therapeutic purposes. Not to be used for routine venipuncture). The physician completed the procedure, but without success. Therefore, no modifier is necessary.

In contrast, if the pediatrician chose to perform only part of a procedure and the CPT code describes a larger service, you would append modifier -52 to the procedure code. For instance, a child complains of hearing loss in the right ear only, so the pediatrician tests that ear only. Assign 92552-52 (Pure tone audiometry [threshold]; air only).