Ob-Gyn Coding Alert

Have your own success story to share? Email the editor. Over-applying modifier 52 may mean you're cutting out ethical reimbursement your physician deserves, and in these tough economic times, that's the last thing you want to do. A subscriber wrote to the editor regarding "3 Details Narrow Down Your Tubal Ligation Coding Options" featured in the Ob-gyn Coding Alert 2010 Volume 13, No.1. The article states, "when the ob-gyn ligates only one tube or places the device on only one tube, CPT indicates that you should add modifier 52 (Reduced services) to the code." This advice would be correct for codes that specify "bilateral" but not for codes specifying "unilateral or bilateral," points out Donna Cuifolo, CCS-P, coding/compliance coordinator at Jamestown Area Medical Associates in N.Y. "Coders need to understand this difference because adding modifier 52 when it is not necessary will inappropriately reduce the payment to the physician," Cuifolo [...]