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Modifier 52 - established/inpatient

  1. Default Modifier 52 - established/inpatient
    Medical Coding Books
    Is it ok to put modifier 52 on a new/established/inpatient hospital visit?

  2. Default
    It doesn't seem appropriate, follow the E&M guidelines and report the appropriate E&M code based on the documentation of history, exam and medical decision making or time if appropriate.

    Hope this helps,
    Anthony McCallum, CPC, CIRCC, CPC-I, CCS

  3. Default
    If the doctor doesnt document enough to even meet a new patient level 1, can they code as a 99201 with a 52 modifier?

  4. #4
    Milwaukee WI
    Default New Patient Office 99201
    The requirements for 99201 are pretty low:
    Problem focused history (Chief complaint and at least 1 element of HPI)
    Problem focused exam (only 1 bullet point)
    Straightforward MDM (0-1 problem point; 0-1 data point; minimal risk)

    That being the case ... some carriers prefer that you use 99499 Unlisted E/M service when your documentation doesn't meet the standard for the lowest level of E/M.

    F Tessa Bartels, CPC, CEMC

  5. #5
    Columbia, MO
    But to answer the question, the 52 modifier is for procedures and is not to be used with E&M codes. I concur with the unlisted code.

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