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ASC modifier -52

Camille Posted Mon 21st of October, 2019 15:39:14 PM
If a surgeon performs 30465 (which includes bilateral procedure) only on the pt's. right sided nasal stenosis, is it necessary for the ASC to use a modifier -52 (30465-SG-52-RT) and take a 50% pmt. reduction? Or is the ASC allowed to bill (30465-SG-RT) and expect the full allowed amount? Per CMS, as of 01/01/2008 Modifier -52 is intended for use to indicate discontinuance of radiology procedures and other procedures that do not require anesthesia. I do not find an appropriate ASC modifier for a planned procedure reduction requiring anesthesiology. I note that codes billed with modifier -74 are paid at 100% of allowable in the ASC. Is it safe for me to assume i do not have to code a right-sided 30465 with any modifier other than (SG and) -RT for ASC coding? Thank you very much!
SuperCoder Answered Tue 22nd of October, 2019 03:23:12 AM
Hi Camille nbsp In ASC setting procedures that are discontinued partially reduced or cancelled after the procedure has been initiated and or the patient has received anesthesia will be paid at the full OPPS payment amount Modifier - is used for these procedures nbsp Procedures for which anesthesia is not...

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