When a provider does not perform an entire intended service or procedure, the reasoning will determine which modifier should be used. Providers sometimes cut services or reduce the procedure for medical reasons. These encounters are then either billed with a modifier 52 or 53.
- Modifier 52-a service that is reduced at the physician’s discretion. For modifier 52 sometimes the code for the procedure stipulates more activity than the condition requires.
- Modifier 53-a patient’s life-threatening condition precipitates the terminated procedure.
The documentation provided for the reduced procedure will be reviewed in order to determine the change in fee schedule, so all services should be documented thoroughly when using modifiers 52 and 53. If the provider attempts the procedure again, when modifier 53 was originally billed, detailed reasoning needs to be provided to explain why the service was first discontinued and the reason the procedure was performed again.