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Correct use of modifier 52

Kathy Posted Thu 29th of May, 2014 16:19:10 PM

Is it appropriate to use modifier 52 (reduced services) on E/M codes?

SuperCoder Answered Thu 29th of May, 2014 16:54:20 PM

Never.

Appropriate Usage
Procedures for which services performed are significantly less than usually required may be billed with the "52" modifier.
Report the service provided with modifier 52 and the appropriate reduced original charge.
Services modified at the physician's discretion to be less than the usual procedure.
When the documentation describing the service fully supports that the service furnished was less than usually required.

Inappropriate Usage
Do not use for terminated procedures.
Do not use for situations when the patient has the inability to pay the full charge.
Do not use on a time based code (i.e. anesthesia, psychotherapy, or critical care).
Do not report on Evaluation & Management and Consultations codes.

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