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Thread: Modifier 52 or 56??

  1. #1

    Unhappy Modifier 52 or 56??

    AAPC: Back to School
    One of our patients was to have an endoscopy procedure, but was unable to be sedated enough to start the procedure. The scope was not inserted. My doctor wants to bill the intended procedure code with a modifier 52 for the preoperative evaluation only. I see modifier 56 covers preoperative care only, but this procedure wasn't split with another provider. I am not convinced that either is correct. Has anyone billed this before?

  2. #2


    I have had this situation come up again with my provider. Can anyone direct me to any literature by CMS that discusses this topic?

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    there is no preop time frame for endoscopies but if the patient was in the procedure room for the endoscopy the bill it with a 53 for the physician, 73 or 74 the facility. Be sure to use a dx code from the V64.x category as a secondary dx code.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default Or ...

    If your doctor really hadn't done anything but evaluate the patient, you could also just code the E/M service performed/documented.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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