Cardiology Coding Alert

Question: I’ve seen conflicting advice about whether I need to send in documentation when I use modifier 52. Can you direct me to an official source?

North Carolina Subscriber

Answer: The Part B MAC for North Carolina, Palmetto GBA, has posted a policy that may help you decide how to handle your claim.

Surgical: If you’re reporting a surgical procedure with modifier 52 (Reduced services), then you should send “a complete operative report and a concise statement explaining the nature of the reduced service.” This policy is based on Medicare Claims Processing Manual, Chapter 12, Section 40.2.A.10 (www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf).

Non-surgical: For non-surgical procedures, you must submit “a concise statement explaining how the service differs from the usual. This statement will only be accepted in the electronic documentation record and Block 19 of the 1500 form.” An example of a short description is “unilateral service.”

If you don’t follow these, rules, Palmetto will reject the claim, and you’ll have to resubmit it. For additional details, review the policy. Start on the Palmetto site www.palmettogba.com/palmetto/providers.nsf/Home_N. Choose JM Part B. On the new page, select Topics/Browse by Topic from the top menu. Scroll down to Modifier Lookup, then choose “CPT® modifier 52.