52 & 22

nlbarnes

Guru
Messages
188
Location
Escondido, CA
Best answers
0
Can you use both modifiers 52 & 22 together? It hit our scrubber. It fits the situation. I think I've successfully billed one that way some years ago.
 

cgaston

Expert
Messages
494
Location
Clarence, NY
Best answers
0
-52 signifies reduced services and -22 signifies increased services.

I can see using them on different codes during the same operative session but not on the same code.
 

CodingKing

True Blue
Messages
3,955
Best answers
1
The modifiers contradict each other so i wouldn't use them both.

Whats the situation, maybe that will allow someone to give you better advice
 

JEYCPC

Expert
Messages
274
Location
Frederick, MD
Best answers
0
How about when you append 52 for a procedure that someone else opened the case and your doc is coming in to do a different service. Which turns out to be far more difficult than the norm. Say it took 25% longer than the average 2 hours it normally takes. And it is well documented.

Playing the devil's advocate.
 
Messages
811
Best answers
0
Can you use both modifiers 52 & 22 together? It hit our scrubber. It fits the situation. I think I've successfully billed one that way some years ago.

You cannot use both a 52 and 22 - the 52 indicates the provider elected not to do a portion of the procedure.

On the flip side, mod 53 indicates the provider discontinued the procedure for extenuating circumstances that put the patient in harm's way. I've seen claims with both 53 and 22.


How about when you append 52 for a procedure that someone else opened the case and your doc is coming in to do a different service. Which turns out to be far more difficult than the norm. Say it took 25% longer than the average 2 hours it normally takes. And it is well documented.

Playing the devil's advocate.

You'd need to give more info. For example, were the procedures related? Why is another surgeon being called in? Was it the same procedure, just half done by one surgeon and half done by another?

Nonetheless, using a 52 indicates the procedure was reduced/not completed by election of the provider. In your example, if the second surgeon is performing another portion of the same procedure, it wouldn't make sense to bill the 52 on the first surgeon's claim because he/she has terminated the procedure. If they are both collectively working on the same procedure that was not terminated, that'd be a co-surgeon situation generally speaking.
 
Top