You Be the Coder: Modifiers 51, 52: Focus on What Services Physician Performed

Question: My ob-gyn did a paratubal cyst excision when done at the time of a c-section. I know to use 4920X based on size, but should I use modifier 52 because the surgeon is already in the abdomen?

South Carolina Subscriber

Answer: The answer depends on who performed what service.

Same physician: You should not apply modifier 52 (Reduced services) to 4920X (Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, 1 or more peritoneal, mesenteric, or retroperitoneal primary or secondary tumors; ...). If the same surgeon who did the delivery did the paratubal cyst excision, then you should treat this as [...]

- Published on 2012-01-17