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Wiki Mod 52

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kristy2

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I bill for a chiropractor. He is using a timed code 97140 that according to the CPT book is "up to 15 minutes". The doctor wants me to bill with mod 52 because he does not do the therapy for the full 15 minutes. I disagree because it is a timed procedure. Any thoughts????
 
The CPT code descriptor does not indicate "up to" it is
"each 15 minutes"

The transmittal below indicates that a single unit should
represent total time = to or > than 8 minutes
(i.e. 1 unit represents 8 thru 22 minutes)

To get the second unit it appears that time would need
to be = or > 23 minutes total.

A CPT Assistant from December 2003 indicates:
"a substantial portion of 15 minutes must be spent in performing
pre-, intra-, and post-service work".....If only a few minutes
are spent performing the manual therapy technique, either
the code should not be reported, or append mod -52.

CMS Transmittal 1019, Aug 3, 2006; Change Request 5253
http://www.cms.hhs.gov/transmittals/downloads/R1019CP.pdf

Hope this helps,
 
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