General Question for the Week of March 8, 2021

General Compliance Question of the Week

Question:

For ultrasound exams that are non-diagnostic due to gas, body habitus, etc. is it appropriate to down code to a limited exam (if ordered as complete) and append a modifier 52?

Answer:

If you change the code to limited, you really don’t need the 52 modifier because 52 is “reduced service,” and limited exams are already reduced services – anything less than complete. If you decide to bill those non-diagnostic exams you can report a limited CPT® code (e.g., 76705 instead of 76700) if there is one, or add modifier 52 if there is no limited exam code (e.g., 76604-52).

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.