When should modifier 52 not be used?

Modifier -52 should not be used if there is another specific procedure code that appropriately describes the lesser or reduced service that was actually performed; the other procedure code is the most appropriate code and should be reported.

What does modifier 52 indicate?

Modifier 52 This modifier is used to indicate partial reduction, cancellation or discontinuation of services for which anesthesia is not planned. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service.

How do you bill an EEG?

For extended EEG monitoring, use 95812, 95813. For ambulatory 24 hour EEG monitoring, use 95950. For EEG during nonintracranial surgery, use 95955.

What is the reduction for modifier 52?

UnitedHealthcare’s standard for reimbursement of Modifier 52 is 50% of the Allowable Amount for the unmodified procedure. This modifier is not used to report the elective cancellation of a procedure before anesthesia induction, intravenous (IV) conscious sedation, and/or surgical preparation in the operating suite.

What is a 74 modifier?

Modifier -74 is used by the facility to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated after the induction of anesthesia or after the procedure was started (e.g., incision made, intubation started, scope inserted) due to extenuating circumstances or circumstances that threatened …

What is the 54 modifier used for?

Modifier 54 indicates that a physician or qualified health care professional (QHP) performed a surgical procedure and transferred the postoperative management to another provider. The 55 modifier indicates that a physician or QHP other than the surgeon performed the postoperative care only.

What are the CPT codes for EEG?

Ambulatory electroencephalography (EEG) should always be preceded by a routine EEG. A routine EEG is described by Current Procedural Terminology (CPT®) codes 95812, 95813, 95816, 95819 or 95822 and refers to a routine EEG recording of less than a 24 hour continuous duration.

What is the 53 modifier?

Bill modifier 53 with the CPT code for the service furnished. This modifier is used to report a service or procedure when the service or procedure is discontinued after anesthesia is administered to the patient.

What is the purpose of modifiers 73 and 74?

Modifier -73 indicates procedures discontinued prior to anesthesia, whereas modifier -74 is appropriate for procedures discontinued after anesthesia administration or after the procedure has begun (e.g., the physician made the incision or inserted a scope).

When to use the 52 modifier in CPT coding?

Modifier 52 is outlined for use with surgical or diagnostic CPT codes in order to indicate reduced or eliminated services. This means modifier 52 should be applied to CPTs which represent diagnostic or surgical services that were reduced by the provider by choice.

When do CPT codes change for EEG recordings?

Familiarize yourself with the 2020 code changes for long-term electroencephalograph recording. Auditing medical claims for long-term electroencephalograph (EEG) and video EEG (VEEG) recordings changed significantly at the beginning of 2020 due to new, revised, and deleted CPT® codes representing these services.

When to use the 52 modifier-continuum rule?

Since modifiers 52 and 53 are closely related, the ‘why’ behind what was done will help clarify which should be used. An important reminder here on the rule with most modifiers: 52 should not be used when a CPT exists that better describes the scenario you’re trying to report by using modifier 52.

Are there any changes to the E-M code?

•Revised Office or Other Outpatient E/M codes 99202-99215 For the complete version of E/M Introductory guideline changes, Office or Other Outpatient (99202-99215) code changes, Prolonged Services code (99354, 99355, 99356, 99XXX) and guideline changes, see Complete E-M Guideline and Code Changes.doc.