-52 modifier and time-based modalities

[Guest guest]

Docs, My office manager just received word from a Blue Cross representative that the -52 modifier is now obsolete and any billing containing this modifier will be rejected. She gave my office manager the impression that there are no more modalities that are based on a unit of time. She stated that it does not matter if you only spend a few minutes or a long period of time performing a non-adjustment therapeutic procedure, it all gets billed the same way. Therefore, do we no longer have the ability to bill for multiple units of a modality anymore? Is time no longer a factor for any of our procedures? The representative stated that all we have to use is the -59 modifier to indicate it was a separate treatment entity compared to chiropractic adjusting. Thanks for your feedback on this matter. Sorah, DCCorvallis, OR

[Guest guest]

Dr. Sorah,

We can and I do bill for multiple units of certain modalities (for example 97124, 97140) over the first fifteen minutes by adding a 2 or 3 in the units section of your billing program (line 24 G) which should automatically change the charge. For multiple use of electrical modalities on different areas of the body @ 15 minutes per area, I just add a second line of billing.

I have been using -59 for some time now to indicate a distinct treatment area or entity. That seems to be working, most of the time, except when the insurance companies are not up to date.

It seems -25 works better for a new examination as a "significant, separately identifiable service" (ChiroCode Book). The examination modalities are coded as to levels of difficulty and thought process, so there is a time-index written into that code and adding -52 won't change payment on those services.

And remeber, the AMA makes up these codes and the insurance companies probably are more quickly aware of changes than you or I.

Christian Mathisen, DC, CCWFN

3654 S Pacific Hwy

Medford, OR 97501

cmathdc@...

-52 modifier and time-based modalities

Docs,

My office manager just received word from a Blue Cross representative that the -52 modifier is now obsolete and any billing containing this modifier will be rejected. She gave my office manager the impression that there are no more modalities that are based on a unit of time. She stated that it does not matter if you only spend a few minutes or a long period of time performing a non-adjustment therapeutic procedure, it all gets billed the same way. Therefore, do we no longer have the ability to bill for multiple units of a modality anymore? Is time no longer a factor for any of our procedures? The representative stated that all we have to use is the -59 modifier to indicate it was a separate treatment entity compared to chiropractic adjusting. Thanks for your feedback on this matter.

Sorah, DC

Corvallis, OR