The key to this description is the phrase "at the physician's discretion," says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for the CRN Institute, an online coding certification training center. This phrase tells the payer that medical decision-making was involved in altering the primary service.
"The physician may determine that it is appropriate to provide the service at a lesser level than the complete description indicates," Jandroep says. "For example, modifier -52 can be used if a procedure is bilateral in nature, but only one side is done."
So if you perform a unilateral x-ray of the acromio-clavicular joint, you should report 73050-52 (Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction). But modifier -52 isn't just for diagnostic x-rays - it also has an important place in RS&I services. Document RS&I Supervision Suppose a breast surgeon performs a mammary ductogram on a single duct. The radiologist does not attend the procedure but interprets the results from the films taken and writes a radiologic report with the findings and conclusions. You should append both modifiers -52 and -26 (Professional component) to 76086 (Mammary ductogram or galactogram, single duct, radiological supervision and interpretation), says Ann Hawkins, senior coder and assistant office manager at X-ray Associates of Louisville, Ky. Modifier -26 demonstrates that the radiologist performed the procedure in the hospital using the facility's equipment, and modifier -52 indicates that it was a reduced service. Hawkins points to Section 15022E of the Medicare Carriers Manual (MCM) to support using modifier -52.
The MCM states, "In order to bill for the supervision aspect of the procedure, the physician must be present during its performance ... In situations where a cardiologist, for example, bills for the supervision (the 'S') of the S&I code, and a radiologist bills for the interpretation (the 'I') of the code, both physicians should use a -52 modifier."
The radiologist's indirect supervision of technical [...]