Oncology & Hematology Coding Alert

Question: If an E/M code requires three components, but we dont have documentation of an exam for a Medicare patient, should I append modifier 52? New Jersey Subscriber Answer: No. CMS states, CPT modifier 52 (reduced services) must not be used with an evaluation and management service. Medicare does not recognize modifier 52 for this purpose, in the Medicare Claims Processing Manual, Chapter 12, Section 30.6.1.B. If no CPT code describes the service as performed, the Manual instructs you to report 99499 (Unlisted evaluation and management service) and include a description of the service with a claim.