Wiki NTs

[barbaraj]

I have a provider that is billing a 76813 with modifier 52 because they are not able to obtain the information they are looking for on the NT (reduced service) . Insurance company will not process the claim. What if she bills 76801 in this case?

 

[Natesmary]

53 vs 52

As I understand it modifier 52 is used if it is known "in advance" that the procedure was not going to be completed. Modifier 53 is used when a planned procedure (or test) cannot be completed. If your provider's intent was to complete the 76813 but was unble to due so "due to extenuating circumstances" you should use modifier 53. This may or may not solve the problem (you will likeley be asked to provide the report) but at least you are on the right track