# Modifier 52 - established/inpatient



## earlec (May 4, 2009)

Is it ok to put modifier 52 on a new/established/inpatient hospital visit?


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## ciphermed (May 4, 2009)

It doesn't seem appropriate, follow the E&M guidelines and report the appropriate E&M code based on the documentation of history, exam and medical decision making or time if appropriate.

Hope this helps,


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## earlec (May 4, 2009)

If the doctor doesnt document enough to even meet a new patient level 1, can they code as a 99201 with a 52 modifier?


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## FTessaBartels (May 4, 2009)

*New Patient Office 99201*

The requirements for 99201 are pretty low:
Problem focused history (Chief complaint and at least 1 element of HPI)
Problem focused exam (only 1 bullet point)
Straightforward MDM (0-1 problem point; 0-1 data point; minimal risk)

That being the case ... some carriers prefer that you use 99499 Unlisted E/M service when your documentation doesn't meet the standard for the lowest level of E/M.

F Tessa Bartels, CPC, CEMC


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## mitchellde (May 4, 2009)

But to answer the question, the 52 modifier is for procedures and is not to be used with E&M codes.  I concur with the unlisted code.


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