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Mod 52

  1. #1
    Location
    Chicopee, MA
    Posts
    14
    Default Mod 52
    Medical Coding Books
    I bill for a chiropractor. He is using a timed code 97140 that according to the CPT book is "up to 15 minutes". The doctor wants me to bill with mod 52 because he does not do the therapy for the full 15 minutes. I disagree because it is a timed procedure. Any thoughts????

  2. Default
    The CPT code descriptor does not indicate "up to" it is
    "each 15 minutes"

    The transmittal below indicates that a single unit should
    represent total time = to or > than 8 minutes
    (i.e. 1 unit represents 8 thru 22 minutes)

    To get the second unit it appears that time would need
    to be = or > 23 minutes total.

    A CPT Assistant from December 2003 indicates:
    "a substantial portion of 15 minutes must be spent in performing
    pre-, intra-, and post-service work".....If only a few minutes
    are spent performing the manual therapy technique, either
    the code should not be reported, or append mod -52.

    CMS Transmittal 1019, Aug 3, 2006; Change Request 5253
    http://www.cms.hhs.gov/transmittals/...ds/R1019CP.pdf

    Hope this helps,
    Anthony McCallum, CPC, CIRCC, CPC-I, CCS
    ciphermed@optonline.net

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