Wiki EP Study's and modifier 52


Andrews, TX
Best answers
Colorado Medicare is denying our claims when we do an EP study (93620) when appended with a 52 modifier. We sent, via fax, per their instruction, the following explaination:

"The 52 modifier was added to CPT code 93620-25-52 as this was reduced service because only one catherter was placed in the right ventricle (RV) and not in the right atrium or HIS bundle. The medical notes are attached for your review."

While they tell us what we have provided is technically correct, they want more information.

Does anyone have any additional information we could provide to them?
I would provide them with the documentation stating WHY a 52 was used. Was patient status deteriorating? Or was there another medical reason for not fully completing components of 93620? Add an addendum for this case, and moving forward, have the physician specifically document reason for 52 and see if you notice an improvement.