Wiki Modifier 52

[johncyrose]

Hi there -

We have a claim that went out with these 2 codes:

43239-52
43236-59

It was denied for incorrect modifier. Should we also add modifier 52 to 43236?

Thank you so much!

Johncy

 

[thomas7331]

It's an unusual combination of modifiers, but assuming this is a physician service, there is nothing technically wrong here that would require a denial - I think you'd need to contact your payer or review their policies to find out why they've denied it. If this is a facility claim, however, modifier 52 is likely not appropriate because for facilities that modifier is only used for procedures that do not require anesthesia, at least under CMS guidance.