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Help with Mod 52 - Reduced Services

  1. #1
    Default Help with Mod 52 - Reduced Services
    Medical Coding Books
    Hello Coders,
    I need your input with modifier 52. One of my doctors is been paid for a new investigational procedure (which is similar to sigmoidoscopy) but with less work done on his part. They are telling me to add mod 52 to get pay less. My understanding is that modifiers are informational - and by attaching it the price is not reduced.

    can anyone help, please...

    Thank you,

  2. #2
    Modifier -52 absolutely will reduce your reimbursement for any procedure code it is attached to.
    Walker Bachman, CPC, CPPM

  3. #3
    Default Mod 52
    Thank you for responding.
    ok so they want me to used 45330 with MOD 52 to get paid less - but do we submit relevant info explaining what the procedures was about. This is a new procedure (investigational).

    So again for educational Purpose: I though using MOD 52 was informative and the prices would not change since the resources are used: room, anesthesia, supplies, RN's, etc...

    Thank you,

  4. #4
    Personally, I think 45999 might be a better code to use. This is not exactly my field of expertise, though. Maybe someone with more experience in this area will have an opinion...
    Walker Bachman, CPC, CPPM

  5. #5
    Smile Mod 52
    Thank you Walker

    Yes, I think I am going advice of the possibility of using 45999.
    your advice was appreciated.
    Have a great weekend


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