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Modifier -52 correct usage HELP!

  1. #1
    Question Modifier -52 correct usage HELP!
    Medical Coding Books
    Please help me on correct usage of modifier -52:

    The scenario is : patient has an ov, 99212, and a lesion removal 17000 and 17110.

    Our rural provider based clinic, (medicare option II) appends the following modifiers:
    99212 -25
    17000-59
    17110-52

    The rationale used is that they don't want to charge a patient the same price for 1 lesion removal as for a patient who has 14 lesions removed.

    They claim that in essence the service is reduced because it is not the same amount of work as if they did remove all 14 lesions. I am concerned about the legality of this. Any input would be appreciated!!

  2. Default
    You state the patient had "a" lesion removal, why would you use two codes for one lesion? Do you have an example of a note?

    Code 17110 states "up to 14 lesions" so you would use that code for 1 lesion removal/destruction and no modifier 52. Reduced services would mean they attempted the removal and less than a removal was done, I don't see that happening.

  3. #3
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    If the provider wants to charge less for one lesion, then I suggest that he/she determine a fee to charge. As mkj2486 stated, modifier -52 is inappropriate; 17110 is for up to 14 lesions, so it doesn't matter if 1 lesion is treated or 14.
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default Wrong modifiers
    Okay - first your question is confusing. BUT ...

    I am going to assume that you have two different lesions, one of which is premalignant, and the other of which is benign ... and that the decision to address them was made at the office visit (i.e. the patient wasn't scheduled to come in for lesion removal/destruction)


    99212-25
    17110
    17000-59

    You should list the procedure with the highest RVU value first.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 01-08-2010 at 04:01 PM.

  5. #5
    Default
    Depending on the type of lesion the first lesion would be 17000 and the second through 14 lesions would be 17003, each listed seperately.
    99212-25
    17000
    17003x number of lesions.
    Cindy, CPC

  6. #6
    Location
    Columbia, MO
    Posts
    12,843
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    Quote Originally Posted by csamps/CPC View Post
    Depending on the type of lesion the first lesion would be 17000 and the second through 14 lesions would be 17003, each listed seperately.
    99212-25
    17000
    17003x number of lesions.
    Cindy, CPC
    I am confused can you provide more information. Were two different lesions removed? what tpue were they? what type of destruction?

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    Columbia, MO
    Posts
    12,843
    Default
    Quote Originally Posted by CGHANKE View Post
    Please help me on correct usage of modifier -52:

    The scenario is : patient has an ov, 99212, and a lesion removal 17000 and 17110.

    Our rural provider based clinic, (medicare option II) appends the following modifiers:
    99212 -25
    17000-59
    17110-52

    The rationale used is that they don't want to charge a patient the same price for 1 lesion removal as for a patient who has 14 lesions removed.

    They claim that in essence the service is reduced because it is not the same amount of work as if they did remove all 14 lesions. I am concerned about the legality of this. Any input would be appreciated!!
    Please clarify as the responses are all over the place. What type of lesions are these and how many exactly.

    Debra A. Mitchell, MSPH, CPC-H

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