Radiology Coding Alert

Get the facts on when modifiers 52 and 53 really apply The next time your physician's documentation reveals an imaging or interventional procedure halted before it meets full code descriptor requirements, don't fret. Follow these expert tips, and you'll be on your way to flawless claims in no time. Check the Reason for Service Reduction Modifier 52 (Reduced services) applies when "a service or procedure is partially reduced or eliminated at the physician's discretion," according to CPT's Appendix A, "Modifiers." You should use modifier 52 when "services are less than described by the code," says Pamela J. Biffle, CPC, CCS-P, ACS-DE, operations director for AAPC e-Learning, headquartered in Salt Lake City. "You don't have to plan on services being reduced to use modifier 52. Often the provider may not know until the service has started." Alternatively: You should append modifier 53 (Discontinued procedure) when the physician elects to terminate a surgical or diagnostic procedure "due to extenuating circumstances or those that threaten the well-being of the patient," according to CPT instructions. Generally, however, if the physician plans or expects a reduction in services, or if the physician electively cancels the procedure before it's complete, you should use modifier 52. Example: Your radiologist isn't present for a percutaneous gastrostomy tube placement, but he reads and interprets the films. You should report 74350 (Percutaneous placement of gastrostomy tube, radiological supervision and interpretation) and append modifiers 52 and 26 (Professional component). Facility tip: In an ambulatory surgery center or other facility setting, the facility reports the appropriate surgical procedure code for the case and appends modifier 73 (Discontinued outpatient procedure prior to anesthesia administration) or modifier 74 (Discontinued outpatient procedure after anesthesia administration), depending on when the physician canceled the case, says Suzan Hvizdash, CPC, physician educator for the University of Pittsburgh and past member of the American Academy of Professional Coders National Advisory Board. But this applies only to the facility billing, not to the physician. Always Search Out Most Appropriate Code If a descriptor specifies a bilateral procedure, but no code describes an equivalent unilateral procedure and the physician provides the service on one side only, append modifier 52. In such a case, you must be certain that there is no designated CPT code to describe the lesser procedure. Example: For a unilateral extremity angiography, you should report 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation) rather than 75716-52 (Angiography, extremity, bilateral, radiological supervision and interpretation; reduced services). Similarly, you should not apply modifier 52 to a "complete" exam code when you have a "limited" code available. Example: If the patient has a left upper quadrant ultrasound, you should report 76705 (Ultrasound, abdominal, real time with image documentation; limited [e.g., single [...]