Do you know the CMS rule for partial S&I services?
If you automatically append modifier 52 every time your report suggests a service that doesn't quite meet a CPT code descriptor, you could be cutting your compensation unnecessarily.
Here's the rundown on when you should--and shouldn't--append 52 (Reduced services). Gather Up CPT and CMS Guidance AMA CPT guidelines explain that you use modifier 52 when the physician partially reduces or eliminates a service or procedure at his discretion, says , vice president of Southeast Radiology Management and FHIMA president-elect.
CMS guidelines say to use 52 "when a procedure/service performed is significantly less than usually required," Buck says.
What to do: Report the usual code for the procedure and append 52 to indicate reduced services, Buck says, citing CPT guidelines.
Example: If your patient has had a left mastectomy and presents for a screening mammogram, your payer may want you to report bilateral code 76092 (Screening mammography, bilateral [two-view film study of each breast]) and append 52 to indicate the reduced service, Buck says.
Caution: Different payers may have different coding guidelines for this service. (See "Consult Mammogram LCD for Mastectomy Patient" in the July 2005
Radiology Coding Alert .) Get the 52/53 Facts Modifier 53 (Discontinued procedure) is not interchangeable with 52. You append 53 to a procedure when an unexpected patient response, such as arrhythmia, causes procedure termination, according to CPT Assistant, December 1996, Buck says. Remember: You use 52 when the physician reduces a procedure at his discretion, not because of a life-threatening situation.
Bottom line: Look for why the physician didn't carry out the full procedure to determine whether you should append 52 or 53, Buck says. Divvy Up S&I Duties With 52
"Radiological supervision and interpretation" (RS&I) codes require performance of the exact services they describe--(1) supervision and (2) interpretation.
"Supervision" means personal supervision, including presence, during the radiologic portion of a procedure, according to CMS, Buck says. Important: Personal supervision is a service to a beneficiary--it is not the same as general supervision, which FIs pay hospitals for as physician services, Buck adds, citing CMS.
A different physician may perform interpretation. CMS says that when one physician, such as a cardiologist, reports the supervision portion of the S&I code and a radiologist reports the interpretation, each physician should append 52 to reflect the reduced service, Buck says.
Watch for: These are CMS' rules. Other payers may not recognize 52, Buck says. Check each payer's guidelines to be sure.
Don't Jump the Gun on 52 Knowing when not to use a fee-reducing modifier can be almost as important as knowing when to use it. Two scenarios below show that you should do your research before appending 52.
Scenario 1: A patient undergoes a CT without contrast, and [...]
