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The individuals who appear are for illustrative purposes. All persons depicted are models and not real healthcare professionals. US-N/A-2400043 05/24

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Determining if a coding modifier is needed, and which one, for an MRI that is discontinued due to patient discomfort

Q.

If a magnetic resonance imaging (MRI) study is not completed due to the patient being in too much pain, how should this be billed for a non-hospital office? We used a 52 modifier, but Medicare is denying it saying that is an inappropriate modifier. Would you just bill it as a regular study?  

A.

If there was enough diagnostic imaging done to obtain a diagnosis, no modifier is needed as there are no specific requirements/elements describing what constitutes a full MRI. If it was not diagnostic, then modifier 53 may be more appropriate for a non-hospital facility or physician billing because that is discontinued service due to extenuating circumstances. 

The complete description for modifier 53 is as follows: 

“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. This circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. Note: This modifier is not used to report the elective cancellation of a procedure prior to the patient’s anesthesia induction and/or surgical preparation in the operating suite. For outpatient hospital/ambulatory surgery center (ASC) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the wellbeing of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for ASC hospital outpatient use).”