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
ciphermed
Guru
It doesn't seem appropriate, follow the E&M guidelines and report the appropriate E&M code based on the documentation of history, exam and medical decision making or time if appropriate.
Hope this helps,
Hope this helps,
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.