Tag Archives: modifier 52
Posted on 25. Jun, 2012 by dchandhok.
Lumbar puncture reporting can become quite challenging when your physician either takes longer than usual with a difficult puncture or decides to discontinue part of the procedure. Read on to know how you can take the pain out of your work.
Ask yourself these modifier questions, whether you’re reporting reduced or difficult punctures or punctures done during global periods.
Is it a Reduced Procedure? Modifier 52 is the Choice
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Posted on 17. Feb, 2011 by dchandhok.
If you mistake modifiers 52 and 53 as one or the other because they’re both used for incomplete procedures, you’ll end up losing your reimbursement. Remember these two have extremely distinctive functions.
Consider a situation when the gastroenterologist performs an esophagogastroduodenoscopy (EGD) to examine the lining of the esophagus, stomach, and upper duodenum of a patient as part of a GERD evaluation.
Suppose that while inserting the endoscope, the patient registers unstable vital signs. The gastroenterologist, then, decides it is not in the patient’s best interest to continue the procedure. You would report this on your claim using:
Posted on 09. Dec, 2010 by jennifer.godreau.
Question: I’m receiving contradictory guidance on which modifier to use when a gastroenterologist does an incomplete colonoscopy. Should I use modifier 52 or 53?
Answer: CPT 2011 ends the days of arguing over whether to use modifier 52 or 53 for an incomplete colonoscopy. If the gastroenterologist could not get beyond the splenic flexure for reasons including poor prep, he is supposed to report 45378 with modifier 52, according to CPT 2010. CMS policy, however,
Posted on 09. May, 2010 by Editor.
The situation is bound to happen: A patient undergoing surgery has complications, and your anesthesiologist must stop his services. Are you prepared to recognize a situation that calls for modifier 53 (Discontinued procedure) or even modifier 52 (Reduced services)? Learn the specific criteria for reporting each modifier to ensure successful coding every time.
Patient Status Often Determines 53 Use
You will use modifier 53 when a procedure ends due to a threat to the patient’s well-being or other extenuating circumstances. For example, the surgeon performs a preop assessment, but during the evaluation he detects a carotid bruit (785.9, Other symptoms involving cardiovascular system), so he delays the surgery indefinitely until a better evaluation can be made.
Posted on 07. Apr, 2010 by Editor.
When your urologist ends a procedure early, you know you need to append a modifier to the procedure code, but the challenge is deciding between modifier 52 or 53. Learn the very specific criteria for reporting each modifier to ensure successful coding every time.
Turn to 52 for ‘Physician Discretion’
You should use modifier 52 when your urologist, while performing a service or procedure, chooses to partially reduce or eliminate a portion of the code’s requirements.
Posted on 12. Feb, 2010 by Editor.
Stuck on how to tackle this op note or those sitting on your desk? Follow this advice, provided by Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M. and co-presenter of the “Ob-Gyn Op Notes” session at the 2009 Ob-Gyn Coding & Reimbursement Conference in Orlando.
Step 1: Itemize procedures.
Step 2: Assign CPT codes.
Step 3: Eliminate “standard” procedures.
Posted on 29. Nov, 2009 by sanjay.aikat.
Question: A sleep study was ordered for a patient diagnosed with hypersomnolence. The neurologistincluded a multiple wake test in the sleep study. What CPT code should I use for the multiple wake test?
Answer: You should use 95805 (Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness). Code 95805 is the only sleep study code (95803-95811) that mentionswakefulness testing. Check if you need a modifier on 95805.
Sleep services codes (95805-95811) include recording, interpretation, and report. For cases when the neurologist does only the interpretation, use modifier 26 (Professional component) on the sleep study code.
All sleep studies must have a minimum of six hours. If the sleep study does not last that long, append modifier 52 (Reduced services) to your code.
The multiple wake test measures the patient’s ability to stay awake during a time when she is normally awake. During the wakefulness test the physician or technologist records the time it takes the patient to fall asleep during a course of four to five 20-minute nap opportunities provided during the testing period in the sleep lab.
The patient does not need to be asleep during the tests.
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Posted on 13. Sep, 2009 by .
Answer: Yes. You can report both the transurethral incision of the bladder neck contracture (TUIBNC) and the fulguration of the bleeding varices your urologist discovered.
First, report 52450 (Transurethral incision of prostate) for the TUIBN. Append modifier 52 (Reduced services) to show that the incision was only at the bladder neck and not the complete prostatic urethra, bladder neck to the verumontanum.
Then, you can also report 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) for the fulguration. Append modifier 51 (Multiple procedures) to indicate that your urologist performed more than one procedure during the operative session.
Skip 51 sometimes: Many payers, including Medicare, no longer require modifier 51. Processing claims electronically allows the payer to recognize when your physician performs multiple procedures and automatically make the necessary reduction in payment. Use ICD-9 diagnosis code 596.0 (Bladder neck obstruction) for the bladder neck contraction and 456.8 (Varicose veins of other sites; varices of other sites) for the prostatic varices.
Posted on 10. Sep, 2009 by .
Answer: The answer depends on whose advice your payer follows.
According to the American Academy of Obstetricians and Gynecologists (ACOG), you should report 58300 (Insertion of intrauterine device [IUD]) and attach modifier 53 (Discontinued service). The ob-gyn started but discontinued the service, and your practice should be able to receive partial payment for this work.
Opponents of this method point out that CPT’s definition of modifier 53 states, “due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued.” CPT’s definition indicates that the physician must also have performed the surgical prep and anesthesia induction prior to discontinuing the procedure. Note that not every patient requires a local anesthetic for the IUD insertion. Also, CPT Assistant December 1996 explains you should use modifier 53 when a patient experiences an unexpected response or life-threatening condition that causes the procedure to be terminated (such as the patient fainting or developing an arrhythmia). In other words, you shouldn’t append modifier 53 to report elective cancellation.
So what’s your alternative? Suppose your ob-gyn had applied a local anesthetic to the cervix prior to the insertion. If the ob-gyn could not place the IUD because the patient has a stenotic cervix, you should consider this a failed procedure. Therefore, experts say you should use modifier 52 (Reduced services).
Posted on 13. Jul, 2009 by .
Answer: When the cardiologist performs right atrial pacing and recording as well as bundle of His recording, but does not perform the other services described in 93619 (Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia), you should not report 93619.
You also should not report 93619-52 (Reduced services) because you have a more appropriate coding option:
• 93600 — Bundle of His recording
• 93602 — Intra-atrial recording
• 93610 — Intra-atrial pacing.
You should report these three individual codes because the cardiologist did not perform and document the other services listed in 93619’s descriptor.