Proper Usage of Modifier 52: When To Use Modifier 52 And When To Avoid Modifier 52

Proper Usage of Modifier 52:

1. Procedure partially completed by provider choice (not safety concerns). Example: Intentional unilateral tonsillectomy by provider, however, code assumes bilateral.
2. When the procedure cannot be completed due to external factors, but not because of risks to the patient’s health.
   Example: A cardiologist begins a balloon angioplasty (CPT 92997) but cannot complete the procedure due to anatomical issues. Modifier 52 is appended to reflect the partial service.
3. For procedures that involve a bilateral or comprehensive service but were only performed on one side or partially.
   Example: An ophthalmologist performs a fluorescein angiography on one eye when the procedure typically includes both eyes.

Improper Use:

1. Modifier 52 does not apply to Evaluation and Management (E/M) codes under any circumstances.
2. If the CPT code already accounts for reduced services, such as unilateral or bilateral descriptions, Modifier 52 is not needed.
3. When a procedure is discontinued due to patient safety concerns, Modifier 53 should be used instead of Modifier 52.
4. If anesthesia has been administered and the procedure is stopped, Modifier 53 or Modifiers 73 and 74 should replace Modifier 52.

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