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Modifier 52?

  1. #1
    Location
    St. Louis, Missouri
    Posts
    262
    Default Modifier 52?
    Medical Coding Books
    My physician was called into a procedure to remove a patient's appendix. The patient was already under anesthesia and was already open for an OB procedure she was undergoing. My physician just came in the OR and removed the appendix and then left. The OB physician finished up their procedure and closed the patient. When I bill for the appendectomy, would I add a 52 modifier because we did not open or close?

    Melissa Blow, CPC

  2. #2
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    yup... you'd need to add add modifier .52 to the incidental appendectomy... although, incidental appendectomy during intra-abdominal surgery does not "usually" warrant a separate identification. (per guidelines in CPT manual)

    {that's my opinion on the posted matter}
    Last edited by dmaec; 08-28-2008 at 02:58 PM.
    Donna, CPC, CPC-H

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default 44955 is add-on code
    The incidental appy CPT 44955 is an add-on code. I don't see how you can bill only this code for your surgeon (even with a -52 mod)

    There also has to be some evidence of medical necessity for removal of the appendix to successfully use this code. Was it inflamed? What was the path report?

    I wonder why the OB-GYN didn't do this procedure him/herself.

    Interesting scenario - let us know how it turns out.

    F Tessa Bartels, CPC

  4. #4
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    If medically necessary, what about 44950 -54?
    Lisa Bledsoe, CPC, CPMA

  5. #5
    Default
    Quote Originally Posted by mmelcam View Post
    My physician was called into a procedure to remove a patient's appendix. The patient was already under anesthesia and was already open for an OB procedure she was undergoing. My physician just came in the OR and removed the appendix and then left. The OB physician finished up their procedure and closed the patient. When I bill for the appendectomy, would I add a 52 modifier because we did not open or close?
    The CPT book states that if it is necessary to report a 44950 with another procedure, you should use a mod. 52.
    Chrissy, CPC

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