Corporate Compliance

Tip: Using modifier -52

Compliance Monitor, September 14, 2005

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This modifier identifies that a service or procedure was partially reduced or eliminated at the physician's election. If a surgical procedure was terminated after the patient has been prepared for the surgery and taken to the room where the procedure is to be performed, but before the induction of anesthesia, add modifier -52 to the intended procedure code. This modifier is used when local, general, or regional anesthesia was not an inherent part of performing the procedure.

  • Code to the extent to which the procedure was performed

  • If no code exists for what has been done, report the intended code with modifier -52

  • Report the five-digit code identifying the service that was initiated and add modifier -52, signifying that the service was reduced

  • If modifier -52 is reported, payments will be 50% of the rate

  • If multiple procedures were planned, only bill for the procedure actually initiated

    The above tip is an excerpt from the book "Modifier Training Handbook for Hospital Billers and Coders," Copyright 2004 by HCPro, Inc. This book is an easy-to-use training guide for billers, coders, and their HIM supervisors and managers that's written in plain English and takes the confusion out of the appropriate use of hospital modifiers.



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