AAPC - Back to school
Results 1 to 4 of 4

Thread: Modifier 52 Reduced Services

  1. #1
    Join Date
    Apr 2007

    Default Modifier 52 Reduced Services

    AAPC: Back to School
    I have been getting conflicating information on the scenario listed below. Hopefully somebody can shed some light on this and help me.

    CPT code 11200 States Removal of skin tags any area up to 15 lesions.

    CPT code +11201 States each additional lesion 10 lesions or PART OF
    Seeing that 11201 say's part of would their ever be a time that you would use modifier 52.

    When you use both of these codes 25 lesions can be removed. What if less than 25 is removed? How many less than 25 would you use modifier 52? Seeing that 11201 says part of does that mean that you would never use modifier 52.

    Any help that somebody can give me would be appreciated.

    Eddie Sottong

  2. #2
    Join Date
    Apr 2007
    Jamaica Local Chapter

    Default Re: Modifier 52

    Modifier 52 is used for surgeries that complications may arise and the Dr. stop the procedure e.g a patient is having breathing problem during the procedure. Your scenario with skin tags do not need a 52. You can bill less than the amount of 10 for the code 11201. For destruction of 18 skin tags, you bill 11200 for 15 and 11201 for remaining 3. I do this everyday and has no problem.
    Ms. B

  3. #3
    Join Date
    Apr 2007
    Nashville AAPC Chapter


    If the physician removed 15 lesions or less use the 11200 CPT code.

    If the physician removes 17 lesions 11200 and add-on code 11201, no modifier needed.

    The phrase "part thereof" of this description means the number of additional lesions removed are between 16 and 25. Your physician is removing portion or "part thereof" of the "10" lesions allowed for this CPT code.

    If more than 25 lesions are removed you can again, use 11201 for a seond time based on the description, regardless if it is 26 lesions or 35 lesions totally removed.

    It would be a misuse of modifier 52, as that is not truly a reduction in services.

    CPT code 11201 does not need a modifier as it is an add-on code.

  4. #4
    Join Date
    Apr 2007

    Default Thank You

    Thank you for providing me with the answer to my question. Two more question about modifiers. Can modifier 57 be used if a doctor see the patient on Monday and decides that he is going to do surgery on Tuesday?

    Modifier 26 I noticed that some codes are add on codes and modifier 26 is being used. Can you use modifier 26 with a code that is a add on code?


    Eddie Sottong

Similar Threads

  1. Reduced AND Increased services
    By JADAMS71 in forum General Surgery
    Replies: 0
    Last Post: 05-19-2014, 09:13 AM
  2. reduced services??
    By lindaf in forum Gastroenterology
    Replies: 2
    Last Post: 06-19-2012, 02:26 PM
  3. Bronchoscopy Reduced Services?
    By SUEV in forum ENT/Otolaryngology
    Replies: 0
    Last Post: 07-30-2010, 11:47 AM
  4. Help with Mod 52 - Reduced Services
    By ecastillo in forum Modifiers
    Replies: 4
    Last Post: 02-26-2010, 01:25 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.