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Modifier 52 Reduced Services

  1. #1
    Default Modifier 52 Reduced Services
    Medical Coding Books
    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
    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
    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
    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

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