Modifier 52 | Reduced Services Explained
Modifier 52 describes reduced services and indicates that the physician did not perform the complete procedure as described in the code descriptor.
1. What is modifier 52?
Modifier 52 indicates that the physician did not perform the procedure described in the code descriptor. It shows that the service provided was less than what was initially planned or expected.
2. When to use modifier 52?
Modifier 52 should only be used when no other code correctly describes the procedure. It is essential to ensure that modifier 52 is appropriate and that it is not being used to reduce the charge for the procedure.
One example of when to use modifier 52 is when a service is performed on one ear, but the code descriptor covers both ears or is bilateral. In this case, modifier 52 would indicate that the service was only performed on one ear.
It is important to note that modifier 52 should not be used with time-based E/M codes. Instead, the appropriate E/M code for the time documented should be reported.
The official description of modifier 52 is “reduced services.” It indicates that the physician did not perform the complete procedure described in the code descriptor.
Examples of procedures that may require the use of modifier 52 include:
- Partial removal of a tumor
- Partial removal of an organ
- Partial closure of a wound
- Partial removal of a joint
Documentation requirements for using modifier 52 include the following:
- A clear and concise description of the procedure performed
- The reason why the procedure was not completed as described in the code descriptor
- The extent of the procedure that was performed
When billing for a procedure with modifier 52, it is essential to bill the insurance the total charge for the procedure and not reduce the charge because insurances reduce payment based on the total charges.
7. Common mistakes
Common mistakes that medical coders make when using modifier 52 include:
- Using modifier 52 to reduce the charge for the procedure
- Using modifier 52 with time-based E/M codes
- Using modifier 52 when another code correctly describes the procedure
To avoid these mistakes, it is important to ensure that modifier 52 is appropriate and that the documentation supports its use.
8. Other modifiers related to modifier 52
Other modifiers related to modifier 52 include:
- Modifier 53 – Discontinued procedure
- Modifier 73 – Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure prior to the administration of anesthesia
- Modifier 74 – Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure after administration of anesthesia
Some additional tips for using modifier 52 include:
- Ensure that the use of modifier 52 is appropriate and supported by documentation
- Do not use modifier 52 to reduce the charge for the procedure
- Be familiar with other modifiers related to modifier 52
Am insurance is denying because the procedure is inconsistent with the modifier used. The modifier in the claim is 52 for a CPT 70551 a MRI Brain W/O Contrast. Insurance was advise that no other modifier can be used but they still deny for the same reason. Can we add another Modifier together with 52?
Hi Omar, you can ask your question here: https://www.codingahead.com/ask-a-question/. We aim to answer your question within 48 hours.