Corporate Compliance

Reporting modifiers for reduced-service echocardiograms

Compliance Monitor, July 6, 2007

Q: Our hospital performed an echocardiogram on a patient; however, the physician dictated that "the study was technically very difficult, and no meaningful information could be obtained."

Our department wants to charge for the time and images obtained, but we're not sure if we should charge a limited amount in this instance since the physician dictated the above information. We were contemplating charging a limited amount and appending modifier -52 (reduced services). Do you have any suggestions on how to handle this scenario?

A: In this circumstance it may be appropriate to charge for the imaging with the addition of a modifier. You may report modifier -52 when certain services are partially reduced or eliminated at the physician's discretion. Since the service was technically provided, even though the result was inadequate to make a diagnostic statement, it is correct to code for the service.

You should also query the physician to determine whether the exam was technically a full/complete exam versus a limited exam, since it may not be apparent from the body of the dictated report. The code assignments differ for a complete exam versus a limited exam and you should assign the most appropriate code.

Under the OPPS, you may append modifier -52 to indicate partial reduction or discontinuation of radiology procedures or other services that do not require anesthesia. Your hospital will receive 50% of the APC reimbursement for the procedure appended with modifier -52.

Source: American Medical Association CPT 2007 Professional Edition, p. 440

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