Wiki Modifier 52

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twingard

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Help Please :confused:

I work in a general practice office and a new patient came in for his initial visit but instead of seeing the patient we had to send him to the hospital via ambulance. A physician saw him in the waiting room and did an assesment on him and took his vitals. She was with him for about 20 minutes until the EMS arrived.

Would I bill a 99202 with modifier 52?
I didn't think we could bill because we didn't cover the 3 key components but with using modifier 52 thought it might be possible.

I guess this has happened in the past and the clinic was not paid because they didn't use a modifier. I've never had to code for this so I want to do it right.....

If anyone can help I would really appriciated it.

Thanks
Tracy
 
you caqnnot use a 52 modifier on an E&M code, if you do not meet the requirements for a particular level you back it down, if you dso not qulaify for the lowest level available then use established patient or unlisted.
 
If your physician admitted the patient then yes bill the admit and if on the same day as the office encounter then you combine the documentation of that encounter to the admit to code the initial level.
 
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