Thursday, May 12, 2011

Modifier 52 can we use when the provider was able to perform only one side?

Q & A about modifiers

Should modifier -52 (reduced services) be used for a procedure that is defined as bilateral by the CPT/HCPCS code when the provider was able to perform only one side of the procedure or service?

Yes.  It is appropriate to use modifier -52, for reduced services on "bilateral" procedures, unless the specific CPT/HCPCS description contains language indicating that the test, procedure, or service is "unilateral or bilateral".   For CPT/HCPCS codes that describe "unilateral or bilateral" language in their respective descriptions, use of the -52 modifier is not necessary since the test, procedure, or service can be performed and paid at the same rate for "unilateral or bilateral" services rendered."

Do I need to append a correct coding modifier to a procedure of a code pair edit if two different physicians performed each of the procedures or if the services were provided on different days?

No. Either different dates of service or different rendering physicians do not meet the criteria for bundling.

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