earlec
New
Is it ok to put modifier 52 on a new/established/inpatient hospital visit?
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Wiki Modifier 52 - established/inpatient
- Thread starter earlec
- Start date
earlec
New
If the doctor doesnt document enough to even meet a new patient level 1, can they code as a 99201 with a 52 modifier?
FTessaBartels
Guest
New Patient Office 99201
The requirements for 99201 are pretty low:
Problem focused history (Chief complaint and at least 1 element of HPI)
Problem focused exam (only 1 bullet point)
Straightforward MDM (0-1 problem point; 0-1 data point; minimal risk)
That being the case ... some carriers prefer that you use 99499 Unlisted E/M service when your documentation doesn't meet the standard for the lowest level of E/M.
F Tessa Bartels, CPC, CEMC
The requirements for 99201 are pretty low:
Problem focused history (Chief complaint and at least 1 element of HPI)
Problem focused exam (only 1 bullet point)
Straightforward MDM (0-1 problem point; 0-1 data point; minimal risk)
That being the case ... some carriers prefer that you use 99499 Unlisted E/M service when your documentation doesn't meet the standard for the lowest level of E/M.
F Tessa Bartels, CPC, CEMC
mitchellde
True Blue
But to answer the question, the 52 modifier is for procedures and is not to be used with E&M codes. I concur with the unlisted code.