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Preventative visit minus pelvic 52 modifier?

jknitz

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If a lady comes in for a preventative exam and lets say she is 40, provider does not do a pelvic and pap, am I supposed to append a 52 modifier to the 99396?

Any comments would be helpful.
jnitz
 

pamtienter

Expert
NAB Member
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349
Location
Mound, MN
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You don't need the 52 modifier. A pap and pelvic isn't necessary to be able bill a preventive exam for a woman. As long as the visit is a comprehensive preventive visit in the eyes of the provider, it can be billed.
 

kevbshields

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Location
Louisville, KY
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- 52 Modifier is not recognized for use with E/M codes. It seems like this popped up a few years back when I was consulting. Evidently it has not gone away . . .

E/M, remember, is structured and tiered so that coders have other options if a comprehensive service was not performed. I realize the Preventive Med section is a bit different, but you've heard from the other posts about that part.
 
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