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Modifier 52 & 53 Denial


For both the modifier OP report must be submitted, according Medicare:
The Medical Review department has determined that many claims are being denied for lack of information regarding modifiers 52 and 53.
Modifier 52 – Reduced Services
Modifier 53 – Discontinued Procedure
If modifier 52 is used and the procedure is surgical, an operative report must be submitted along with the claim and a separate concise statement indicating how the service differs from the usual. If the reduced procedure is non-surgical, a statement or report must be submitted describing how the service performed differs from the usual.
If modifier 53 is used for a surgical procedure, an operative report is required.
If the procedure is not surgical, a statement or report of how the procedure performed differed from the usual must be submitted with the claim.

Comments

  1. AmeliaMarch 8, 2012 at 11:37 AM

    I think that any kind of medical billing is worth looking into if it is efficient, and helpful to both parties. The one paying and the one getting paid. It's only fair.

    ReplyDelete
  2. UnknownJanuary 18, 2013 at 4:20 AM

    We always yell about issues with the health care system but we have to admit some things are quite operative. You only pay the co-paid, thanks to the Medical Billing in Florida and to the tremendous amount of work behind.
    Medical Billing in Florida

    ReplyDelete
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  4. Noah liamJanuary 5, 2022 at 11:52 PM

    Nice blog. Thanks for sharing it. Approaching a medical coding company to perform medical coding process for healthcare organization can reduce the operating costs. Medical Billing Services coding process helps physician to be less stress and will not be burdened with extra work and allow to focus more on patients care.

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