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Modifier 52 - would be coded

  1. #1
    Default Modifier 52 - would be coded
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    I am double-checking to see how a case would be coded.

    The above codes list what would have been coded if the Radiological procedure had been performed. Instead, the patient was quickly examined by the Radiologist and it was determined that because of the discharge from the ducts, that the ductography was not a suitable procedure to be performed. To summarize the visit, quick hands on exam, review of the current mammo vs. that previous mammo, and the determination to send the patient for a surgical referral.

    What would be the correct way of reporting this or would this service not be reported at all? I struggle with submitting it was a modifier 52 for reduced services but this is all new to me and want to make sure that we bill it correctly.

    Someone told me that they would code it with a modifier 53 but modifier 53 is to be used when the procedure is discontinued after the induction of anesthesia and it was terminated because of the risk to the patient's well-being. This procecedure was cancelled only after the radiologist did a quick exam.

    Any ideas or feedback or advice would be greatly appreciated.

    Alison, CPC, CEMC

  2. #2
    Milwaukee WI
    Default Code the E/M
    I would code only the E/M performed and documented (i.e. the evaluation/exam/decision to refer). It does not sound as if any procedure was performed at all.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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