ED Coding and Reimbursement Alert

Avoid Modifier -52 and -53 Denials With These 3 Guidelines
 
You've decided between modifiers -52 and -53, and you've chosen a charging option - but all that critical thinking won't matter if your claim doesn't get through your carrier's door. Follow these field-tested strategies to cinch your reimbursement every time.
 
File a paper claim. Even though you can file electronic claims when appending certain other modifiers - and get paid for the services - payers aren't so generous with modifiers -52 and -53. Because these modifiers denote unusual circumstances, claim-handlers manually review them.
 
Don't increase or reduce your fees. The insurance company will do this for you based on the amount of the procedure the doctor completed. Like salary negotiation and car-buying, naming a price outright could cheat you out of reimbursement you deserve.
 
Provide rock-solid documentation. Include a description of the patient's condition, name the planned procedure, describe the extenuating circumstances, and then explain what happened. Give a detailed summary of the amount of time and work involved, and write a few quick paragraphs outlining medical necessity and why the physician discontinued the procedure.