Radiology Coding Alert

Question: Our radiologist had to terminate an ultrasound (US)-guided percutaneous breast biopsy midway through the procedure due to the patient experiencing a syncopal episode. Are there any guidelines for whether I should use modifier 52 or 53 in this case?

Mississippi Subscriber

Answer: Appending modifier 53 (Discontinued procedure) to 19083 (Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance) is appropriate for terminated surgeries “due to extenuating circumstances or those that threaten the wellbeing of the patient,” according to the CPT^® code book. Your example warrants the use of modifier 53.

While not applicable in this instance, you should also keep in mind that according to Appendix A in the CPT^® code book, 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.

You may use modifier 52 (Reduced services) in a variety of contexts, but not this example. For instance, you can append it to surgical codes that are inherently bilateral but that your surgeon performs unilaterally.