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Modifier 22, 52 & 53



Above mentioned three modifiers are used in your claim to get paid, but you need to have supporting document to get paid. 

Also your documentation needs to explain why the services required more/less/stopped services in midway. 

You should be very careful when you use modifier 22, 52&53.

Modifier 22:

Description: Service that required significantly greater effort than typically required.

Increased procedural services, this modifier used when you update it means physician performing the service more than the actual requirement, as mentioned above you need to have supporting documentation to get paid. Also we cannot use this modifier for E&M services and with 63 modifiers. In below scenario you can use this modifier.

Patient condition
Physical effort requirement
Mental effort requirement
Time and Technical difficulty

Modifier 52:

Description: Reduced Services

Reduced services, this modifier used when services is reduces / practically stopped than the actual requirement, you need to have documentation for modifier 52 for claim to be get paid. Again we cannot use the modifier with E&M services. In the below scenario you can use modifier 52.

Some surgery requires other surgeon to perform the part of the surgery that time you can use this modifier.

Modifier 53:

Description: Discontinued procedure

Discontinued procedure, this modifier used when the services discontinued, this modifier should be used for a Surgical or diagnostic procedure code when the physician elects to terminate the procedure. We need to have supporting document for use the modifier 53. Also we cannot use the modifier with E&M procedure.

Services discontinued due to patient well being.

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