Sunday, March 13, 2011

Correct use of 52 modifier & incorrect use of 52 modifier

Surgery Reminder - Using 52 Modifier

52 Modifier – May be billed for surgeries in which the services performed are significantly less than usually required, i.e., the surgery described by the CPT code included services or portions of a service that may not need to be performed or were never planned to be performed during the encounter. If there is another CPT code that more accurately describes the portions of the service provided, that code should be billed and the 52 modifier should not be used.

Example of correct use of 52 modifier:

Example: Hearing test – CPT code 92552© (pure tone audiometry, air) is going to be performed on only one ear. The CPT code is for a bilateral procedure and there is no separate code for a unilateral procedure. The provider starts the test with the knowledge and plan that he will only be testing one ear. The provider bills CPT code 92552 with the 52 modifier indicating that the procedure was reduced. A narrative note on the claim should indicate why the 52 modifier was used and the procedure code reduced. (No operative note is necessary since this is not a surgical procedure.)

Example of incorrect use of 52 modifier:

Example: Colonoscopy – Scoped to just past the splenic flexure and stopped due to tortuous colon.
Provider billed CPT code 45378© (diagnostic colonoscopy) with the 52 modifier. Because the procedure was discontinued, the provider should have billed with the 53 modifier.

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