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modifer 52 vs 74

  1. Default modifer 52 vs 74
    Medical Coding Books
    If a patient comes is for colonoscopy that does NOT reach the splenic flexure because of adhesions. Which modifer is used 52 or 74?

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    74


    ? If covered, pay for the ASC facility fees for interrupted screening colonoscopies, codes G0105 73 and G0121 73 at a rate consistent with the ASC facility fee for interrupted diagnostic colonoscopies, code 45378 73, using the methodologies for incomplete procedures indicated in the Medicare Carriers Manual (MCM), Section 5243.4.

    ? If covered, pay for ASC facility fees for interrupted screening colonoscopies, codes G0105 74 and G0121 74, at a rate consistent with the ASC facility fee for interrupted diagnostic colonoscopies, code 45378 74, using the methodologies for incomplete procedures indicated in MCM, Section 5243.4.

    Applies to the states of: AK, AZ, CO, HI, IA, NV, ND, OR, SD, WA and WY.

    Effective Date: January 1, 2004
    Last edited by mbort; 10-21-2009 at 02:35 PM. Reason: added supporting documentation
    Mary, CPC, CANPC, COSC

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