Wiki modifier 52 and injectible medications

[jtetrault]

Our orthopedic MDs often do cortisone injections to treat different medical conditions. One of the medications is described by code J0702 as 3 mg of Celestone. On occasion the physician may only injection, for eg, 2 mg of Celestone. Is it appropriate to add modifier 52 to the code indicating that the service was reduced in some respect, Or should we not bill for the medication at all as the exact amount of medication injected does not completely fit the procedure code? It doesnt seem quite right that reimbursement should be lost if the code cannot be modified. Our local Medicare Contractor is NHIC. Thanks for the help!

 

[sthibo]

After reading your description, it looks like the procedure was complete but the medication dosage was reduced at the descretion of the physician. Has this already been denied?

 

[jtetrault]

To date I have received payments using the modifier -52 from BCBS of MA, Harvard Pilgrim, Medicare and denial from Mass health. Thanks for your input!