Home > Coding Modifier 52 versus Modifier 53

Coding Modifier 52 versus Modifier 53

April 13, 2023

Modifier 52, Reduced Services, and Modifier 53, Discontinued Services are similar but very distinct circumstances. Regardless, to utilize either of these modifiers, the documentation will need to show why the provider stopped or otherwise cut a procedure short while they were performing it.

In our CPT Appendix A, Modifier 52 is defined S Reduced services, under certain circumstances service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional, under these circumstances the service provides can be identified by its usual procedure number and the addition of modifier 52, signifying that the services are reduced.

Modifier 53 in our CPT Appendix A is defined as Discontinued Procedure, under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the wellbeing of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. The circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued. Modifier 53 may also apply if the provider must stop a procedure due to equipment failure or other extenuating circumstances (for example, the provider injures themselves while performing the procedure).

So how can you tell if modifier 52 or modifier 53 is most appropriate while coding? Something to remember is modifier 52 applies when a reduction in service occurs by choice (either the provider’s or patient’s).

Key words or phrases to consider modifier 52 would be the use of the word partially, to be reduced, or part of procedure was not completed. Phrases to be considered for the use of modifier 53 would be, procedure stopped before completion, no need to complete procedure.

Q: A surgeon has a patient under anesthesia and fully prepared to proceed with surgery. However, the physician cuts himself and therefore cannot carry out the operation. What modifier is most appropriate?

A: Modifier 53 may be applied to the CPT code to indicate an extenuating circumstance that prevented the procedure from being performed.

Reference: FY 2023 CPT Appendix A, CPT Assist

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Amar A. Desai, MD, MPH

CEO, Optum Health

Dr. Amar Desai is a physician, public health leader and health care executive with over two decades of experience transforming the healthcare system and helping patients lead healthier, more fulfilled lives.

Through his work at the intersection of direct patient care and health care systems, Dr. Desai has developed innovative delivery models that improve clinical outcomes, increase affordability, and transform the experience of being a healthcare consumer. By translating clinical excellence into economic value, Dr. Desai has improved care delivery in a range of settings, including early-stage start-ups, organizational turnaround, Fortune 200 companies, and academic health systems.

Currently, Dr. Desai serves as President for Health Care Delivery at CVS Health where he is responsible for the company’s health services organization and care delivery strategy across primary care, physician enablement, and technology enabled value-based care. In his role, he oversees retail health, behavioral health, and the development and implementation of payor-agnostic products and services.

Prior to his current role, Dr. Desai served as President and CEO of Optum Pacific West, building and operating the largest multi-payor value-based care delivery organization in the country. In this role, he oversaw Optum’s care delivery organizations throughout California, Oregon, and Washington comprised of more than 20,000 physicians and serving 2.5 million patients.

Prior to his current role, Dr. Desai served as the President of HealthCare Partners, a leading integrated delivery network serving over 700,000 patients. Dr. Desai also served as CEO of University of Southern California (USC) Care where he led transformative growth and positioned the university’s medical center as a regional leader for complex care. Prior to USC, Dr. Desai was a senior executive at DaVita, a global leader in dialysis care, where he advanced integrated kidney care models and led corporate strategy for the enterprise.

Early in his career, Dr. Desai served as an engagement manager at McKinsey & Company. Dr. Desai received his Bachelor’s and Medical Degrees from Brown University, and his Masters in Public Health at Harvard T.H. Chan School of Public Health. He completed internal medicine residency and nephrology fellowship at the University of California, San Francisco. He is currently an Associate Clinical Professor of Medicine at Keck School of Medicine at USC and has previously held faculty appointments at Stanford School of Medicine and the David Geffen School of Medicine at UCLA.

Paul Klotman, MD, FACP

President, CEO and Executive Dean, Baylor College of Medicine

Dr. Paul Klotman began serving as president and CEO of Baylor College of Medicine on Sept. 1, 2010. He received his B.S. degree in 1972 from the University of Michigan and his M.D. from Indiana University in 1976. He completed his medicine and nephrology training at Duke University Medical Center. He stayed at Duke as a faculty member, rising to the rank of associate professor of medicine before moving to the NIH in 1988, where he became chief of the molecular medicine section in the laboratory of developmental biology. In 1993, he became chief of the Viral Pathogenesis Laboratory in the NIDR/NIH. In 1994, he moved to Mount Sinai School of Medicine as the Irene and Dr. Arthur M. Fishberg Professor of Medicine and the chief of the division of nephrology. In 2001, he was selected to be the chair of the Samuel Bronfman Department of Medicine of the Mount Sinai School of Medicine. The College’s Board of Trustees named him as the school’s new president in July of 2010.

Klotman’s research has been a blend of both basic and clinical research in molecular virology and AIDS pathogenesis. He developed the first small animal model of HIV associated nephropathy using transgenic techniques. He is the author of more than 200 publications, and he has been a visiting professor and lecturer internationally in the field of HIV pathogenesis. He has been elected to both the American Society of Clinical Investigation and the Association of American Physicians. He is on the editorial boards of journals both in the United States and in Europe, and he has served on and chaired numerous study sections including those from the NIH, the American Heart Association, the National Kidney Foundation, and the VA research service.

In addition to his laboratory efforts, Klotman has been an active clinician, teacher and mentor. Students from his laboratory have won prestigious scientific competitions. He has trained more than 50 clinical fellows, postdoctoral fellows, and students in his laboratory since 1984, most of whom are independently funded. And, he was named Physician of the Year by Mount Sinai nurses. As the chair of medicine, he moved the department of medicine at Mount Sinai to a top tier academic program by expanding the faculty practice, increasing basic and clinical research revenues, developing new community projects and focusing on the educational mission.

Klotman serves on the scientific advisory boards of biotech, pharmaceutical and healthcare companies. He also serves on the board of several companies including those with interests in natural resources and conservation.

At Baylor, he oversees the only private health science university in the Greater Southwest, with research funding of nearly $400 million. The medical school is ranked as one of the top 25 for research and one of the top ten for primary care by U.S. News & World Report. The School of Health Professions is among the best 15 in the nation and the Graduate School of Biomedical Sciences is rated in the top five percent. In addition, the College is home to the first National School of Tropical Medicine in North America. The College is ranked first among all Texas colleges, universities and medical schools in federal funding for research and development, and is ranked second in federally funded research expenditures by the National Science Foundation.

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Senior Vice President, Care Design & Innovation

Dr. Crocker is responsible for designing new products and solutions as well as refining/improving existing services within the Clinical Care Solutions pillar of IKS Health’s Provider Enablement Platform for both current and prospective clients. He is passionate about team-based care and culture, technology and innovation, and the patient voice in healthcare transformation.

Dr. Crocker is a general internist/primary care physician and most recently served as Medical Director of the Ambulatory Practice of the Future (APF) at MGPO, where he provided clinical care and conducted collaborative research in the application of technologies to the field of primary care to enhance the knowledge and quality of innovative, patient- centered, team-based care.

Dr. Crocker brings over 20 years of clinical experience and thought leadership in team-based, patient-centered primary care, clinical operations, and healthcare innovation. In 2010, he co-founded and later served as medical director of one of Massachusetts General Hospital’s (MGH) premier primary care practices in Boston, MA. He has participated in multiple aspects of practice design and operations improvement. He is published on a wide range of topics including post-discharge telephone follow-up, point of care testing, technology-assisted apprenticeship in chronic disease management, embedded health and wellness coaching, and the patient-centered medical home. Dr. Crocker also helped establish the first practice-centered PFAC (patient-family advisory committee) in his organization.

Dr. Crocker is the co-founder of the APF Innovation Learning Program which established a “living laboratory” within the clinical primary care environment to partner with academic and industry leaders to explore, design, create and test technological solutions to present and future day challenges in primary care. While there, he spearheaded the design, implementation, and scaling of what is now IKS’ AssuRx centralized prescription renewal service to reduce staff administrative burden and introduce a new standard of safety in the prescription-renewal process. He also led primary care-based Scribble and New Chart Prep implementation and utilization.

A graduate of Tuft University with a B.S. in Chemical Engineering, Dr. Crocker received his medical degree from the University of Massachusetts Medical School, and attended Boston University Medical Center for residency in Internal Medicine as well as an additional year as chief medical resident.