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Use of 52 Modifier

  1. #1
    Chesapeake, VA
    Default Use of 52 Modifier
    Medical Coding Books
    If a surgeon performs a temporal artery biopsy but the path report indicates no artery in sample (just some fibrous tissue and a lymph node), would it be appropiate to code CPT 37609 with a 52 modifier? The descriptor reads, Ligation or biopsy, temporal artery; (and no ligation was done).
    I could use some help on this one.
    Thank you,

  2. #2
    Albany, New York
    Descriptor reads "Ligation or biopsy.

    I would not use Modifier 52 in this case.

    Can you provide further details of the procedure?
    Karen Maloney, CPC
    Data Quality Specialist

  3. #3
    Default Response
    I agree, I would not use a reduced services modifier because with the description provided does not indicate that the service was reduced or eliminated. The code description includes the services that may or may not be included during the surgery that satisifies the assignment of the code. I hope this help. Appendix A in the CPT book gives a better description of the use of modifier -52 and CPT coding desk reference from ingenix may help when assigning procedural codes.


  4. Default
    52 modifier does not seems right,
    before suggesting anything i will like to know the full documentation.

  5. #5
    Chesapeake, VA
    Default Use of 52 modifier
    Thanks everyone for your input. Obviously the doctor believed he biopsied the temporal artery, the op report read sampled "what appeared to be" the artery. I was trying to find some guidance on the correct coding principal to apply here.

    I guess the message I am getting is that the code is based more on what the doctor thinks he did rather than what was actually accomplished. So based on this principal, a liver biopsy that yields no liver or a muscle biopsy that consists solely of subcutaneous tissue and fat but again, no muscle, would still be coded and billed as completed procedures; (despite the fact that the intended organ was not biopsied). I hope I am interpreting this correctly.
    The Ingenix Modifier manual said the 52 modifier is used when the outcome is less than expected which is why I had initially thought it may apply here.
    Thank you again for your help.

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