tci Part B Insider - 2012 Issue 5

Reader Question: Modifier 52 Can Be Your Ally

Question: If we perform a unilateral imaging service and the only available code specifies bilateral, should we use an unlisted code?Answer: Rather than using an unlisted procedure code such as 76499 (Unlisted diagnostic radiographic procedure), you should append modifier 52 (Reduced services) to the bilateral code. Modifier 52 will let the payer know you did not perform the full service as described. Medicare supports this use in a Q&A updated Aug. 9, 2011, in which the agency says, "It is appropriate to use modifier 52, for reduced services on 'bilateral' procedures, unless the specific CPT/HCPCS description...

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