Coding Question of the Month

Each month, we feature the most frequently asked question received by ACOG’s Coding Department, and our response. 

What is the difference between modifier 52 (reduced services) and modifier 53 (discontinued procedure)?

Answer: Modifier 52 (Reduced services) is used when:

  • One procedure is attempted but was unsuccessful, and another procedure was then performed during the same surgical session; OR
  • The physician did not perform all the components described in the code.

As an example, for Current Procedural Terminology (CPT) code 58565 (Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants), provides the following instruction, “For unilateral procedure, use modifier 52.” This should be interpreted to mean that because code 58565 is a bilateral procedure, when it is performed unilaterally, coding is as follows: 58565-52. Modifier 52 is assigned because all of the components of code 58565 were not performed.

Modifier 53 (Discontinued Procedure) is used when the patient has undergone anesthesia induction and/or surgical prep but the planned procedure was not completed. No other procedure is performed during the surgical session. If the procedure is terminated after significant physician work, and another approach is then used to accomplish the surgery, report ONLY the successful surgery with modifier 22 (Increased procedural services) instead of modifier 53. 

(August 2016)


 

Contact:

Donna Tyler
Director, Coding
dtyler@acog.org

Keisha Sutton
Coding Specialist
ksutton@acog.org

Tara Johnson
Program Specialist
tjohnson@acog.org

American Congress of Obstetricians and Gynecologists
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