Tuesday, March 8, 2011

USAGE of Modifier 52 - Reduced services

When To Use Modifier 52

Modifier 52 Reduced Services; is used when a service / procedure was not completed in its entirety.

You must review all documentation with the physician. Modifier 52 pertains to opening and closing of a procedure. Some clinics and surgery centers decided not to append modifier 52, because the reimbursement would not be worth the time and effort compare to the time it normally takes to open and close .

When a surgeon does not complete a procedure in its entirety the procedure must be billed by appending modifier 52. The reimbursement will be based on what was completed and accomplished. A code will be assigned to indicate the portion of the procedure that was completed. The operative report must be attached for determination reimbursement. 

If  found that there is no comparable code to determine reimbursement, the Medicare Pre-operative, Intra-operative, Post-operative percentages will be used for deciding reimbursement.  You could be losing hundreds of dollars, by appending modifier 52, to cases where your surgeon completed the entire procedure but not the open and close tasks.

Now if you have a co-surgery situation  your surgeon did not open or closed the procedure, you must report the code and append modifier 52.

“Example: An orthopedic surgeon performing a procedure and sees a mass in the thoracic area,(breast area) your general surgeon is called in and does a lumpectomy, you would code the lumpectomy and append modifier 52, as your surgeon did not open and close the procedure,”

Do not use modifier 53, as is only used for discontinued procedure due to mitigating circumstances or those threatening the life of the patient and procedure was discontinued.

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