The correct application of modifiers 52 and 53 can be very confusing. Although the descriptions can be puzzling, there are distinct differences between the two.

Modifier 52 should be appended to a procedure code whenever the service or procedure is partially reduced or eliminated at the physician's discretion. In other words, the procedure or service was started, but the physician elected to discontinue it. This modifier is normally assigned to a procedure or surgical code. For example, a physician is unable to remove a foreign body from a child's ear. The physician elects to discontinue the procedure and refer the child to an ear, nose, and throat specialist. The physician would report code 30300-52 (removal foreign body, intranasal).

It is uncommon for modifier 52 to be appended to an evaluation and management (E/M) service because when an E/M service is reduced, a lower level of service would be reported. However,...

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