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modifier 52 on timed codes

  1. #1
    Location
    ST Paul, MN
    Posts
    21
    Default modifier 52 on timed codes
    Medical Coding Books
    Here's my question: AMA standards state that the timed codes under the medicine section (97124, 97140, 97535, etc) are billable when at least 8 minutes of the procedure is done. If less than 8 minutes are done then the procedure should not be billed. What if modifier 52 (reduced services) is added to the CPT code. Example, CPT 97124 is done for 18 minutes. Should only 1 unit be billed, or could it be billed as 97124 and 97124 52?
    Brian Johnsen, CPC
    St Paul, MN

  2. #2
    Location
    ST Paul, MN
    Posts
    21
    Default
    Better example of my question. 5 minutes of ultrasound (97035) is performed. Should it billed as 97035-52 at a reduced $ amount? Or not billed at all? Any thoughts are appreciated!
    Brian Johnsen, CPC
    St Paul, MN

  3. #3
    Location
    Columbia, MO
    Posts
    12,907
    Default
    Ok a time code must have a minimum of 50% of the required time. For a 15 minute code you must have a min of 8 minutes to bill 1 unit anything less than 8 minutes cannot be billed and you cannot use a 52 modifier. Then to bill the next unit you must have 8 minutes into it. For example
    For a 15 minute code, you need 8 minimum
    So 8 - 15 minutes but to be able to bill the next unit you must have an additional 8 minutes
    So
    8-22 minutes is one unit
    23 - 37 is 2 units
    38 to 52 is 3 units
    And so on
    And again no to the 52 modifier.

    Debra A. Mitchell, MSPH, CPC-H

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