It seems that the application of modifiers is increasingly required to get claims paid accurately. One major dilemma in modifier application for physician services is correctly applying modifier 52 versus modifier 53.

Modifier 52 (reduced service) reports a partially reduced or eliminated service or procedure.

Appropriate use of modifier 52 would be on procedures for which intended services performed are significantly less than usually required per the Current Procedural Terminology (CPT®) code description. When the documentation describing the service fully supports that the service furnished was less than usually required and no other code more accurately describes the service provided, modifier 52 is appropriately applied. This may be applicable to services described as or assumed to be bilateral when only a unilateral service is performed but would not apply to a service described in CPT as “unilateral or bilateral” as that service is complete whether performed unilaterally...

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