Modifier Coding Alert

Published on Fri Sep 19, 2014 PDF

Question: A physician in our office expected to perform a bilateral tonsillectomy, but ended up only removing one tonsil. How would I code this?

Alabama Subscriber

Answer: First, you would submit 42820 (Tonsillectomy and adenoidectomy; younger than age 12) or 42821 (Tonsillectomy and adenoidectomy; age 12 or over), depending on the patient’s age. Attach modifier 52 (Reduced services) to the procedure code to indicate that your physician performed less than what the code descriptor indicates.

Using modifier 52 indicates a partial reduction or discontinuation of procedures and services. A reduction is when a procedure or service is less than the CPT® descriptor or less work than normal. Modifier 52 provides a way for reporting reduced procedures without interfering with the primary service.