Tip: Know when to properly append modifier -52
APCs Weekly Monitor, October 22, 2010
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Modifier -52 (reduced services) indicates that a service was partially reduced or eliminated at a physician’s discretion, per the CPT Manual. When a physician performs a bilateral procedure on one side only, append modifier -52. However, if the code description includes “unilateral or bilateral,” do not append modifier -52.
For example, if a physician performs a unilateral tonsillectomy on a 10-year-old patient (CPT code 42820), append modifier -52.
If a physician performs a unilateral nasal endoscopy (code 31231), do not append modifier -52 because the code description states unilateral or bilateral.
Also, don’t use this modifier if an existing CPT or HCPCS code properly identifies the reduced service. For example, a patient is set to undergo a two-view chest x-ray, but only one image is obtained. In this case, report code 71010 (radiologic examination, chest; single view, frontal) instead of 71020 (radiologic examination, chest, two views, frontal and lateral) with modifier -52.
This tip was adapted from “Messy modifiers: -25, -52, -58, -78, and -59 explained” in the October issue of Briefings on APCs.
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