Wiki Modifier 52 added to 76830??

[bkhughes]

Patient is status post hysterectomy and is having a transvaginal US for pelvic pain. Since there is no uterus would you add a 52 modifier to 76830, the physician did state in the findings that she was s/p hysterectomy, so there was a reason the uterus was not seen or evaluated. According to ACR 2022 US Coding User's Guide if evaluation of the uterus is not documeneted, modifier 52 should be applied.

 

[Deborah Marsh]

Hi - Based on CPT guidelines, you shouldn't need modifier 52. You say "the physician did state in the findings that she was s/p hysterectomy, so there was a reason the uterus was not seen or evaluated." Per the CPT guidelines, "For those anatomic regions that have "complete" and "limited" ultrasound codes, note the elements that comprise a "complete" exam. The report should contain a description of these elements or the reason that an element could not be visualized (eg, obscured by bowel gas, surgically absent)." CPT Assistant (May 2023) also had a question about 76830 and said "If all the required elements are not described and the reasons for nonvisualization are not given within the radiology report, then the examination would be considered a limited study and should be reported either with the appropriate limited examination code(s) or modifier 52, Reduced Services, appended if no limited examination code exists."