Radiology Coding Alert

How to designate 'reduced services'

Radiologists frequently report the radiological supervision and interpretation (RS&I) codes, which describe the physician's work supervising a procedure and interpreting the results. But if your radiologist performs just the interpretation services and does not attend the procedure, you should append modifier -52 to your RS&I code(s).

Show a Change in the Service With -52

CPT Codes defines modifier -52 (Reduced services) as follows: "Under certain circumstances a service or procedure is partially reduced or eliminated at the physician's discretion. Under these circumstances the service provided can be identified by its usual procedure number and the addition of the modifier '-52,' signifying that the service is reduced."

The key to this description is the phrase "at the physician's discretion," says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for the CRN Institute, an online coding certification training center. This phrase tells the payer that medical decision-making was involved in altering the primary service.

"The physician may determine that it is appropriate to provide the service at a lesser level than the complete description indicates," Jandroep says. "For example, modifier -52 can be used if a procedure is bilateral in nature, but only one side is done."

So if you perform a unilateral x-ray of the acromio-clavicular joint, you should report 73050-52 (Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction). But modifier -52 isn't just for diagnostic x-rays - it also has an important place in RS&I services.

Document RS&I Supervision

Suppose a breast surgeon performs a mammary ductogram on a single duct. The radiologist does not attend the procedure but interprets the results from the films taken and writes a radiologic report with the findings and conclusions.

You should append both modifiers -52 and -26 (Professional component) to 76086 (Mammary ductogram or galactogram, single duct, radiological supervision and interpretation), says Ann Hawkins, senior coder and assistant office manager at X-ray Associates of Louisville, Ky. Modifier -26 demonstrates that the radiologist performed the procedure in the hospital using the facility's equipment, and modifier -52 indicates that it was a reduced service. Hawkins points to Section 15022E of the Medicare Carriers Manual (MCM) to support using modifier -52.

The MCM states, "In order to bill for the supervision aspect of the procedure, the physician must be present during its performance ... In situations where a cardiologist, for example, bills for the supervision (the 'S') of the S&I code, and a radiologist bills for the interpretation (the 'I') of the code, both physicians should use a -52 modifier."

The radiologist's indirect supervision of technical personnel within the radiology department is not considered part of the RS&I code. Instead, Medicare considers it a "Part A" service, similar to providing supervision for quality assurance.

Show the Payer Why You Used -52

If you append modifier -52 to your radiology codes, always send your carrier documentation explaining why the service or procedure was reduced. In addition, you should ask the radiologist to write a short cover letter explaining the circumstances that led him or her to decide to reduce the service.

Most carriers don't require you to submit your procedure notes with the claim, but you should always maintain documentation of the service in the patient's file.