Reduced services claims often require more than just encounter notes.
It’s a denial that’s all too common; you submit a claim for reduced services with modifier 52 (Reduced services) appended, and all is well. Correct?
Well …: The claim might pass muster with the payer; to solidify your claims against denials, however, you should always include the proper documentation. Check out these tips from CGS Medicare toward maximizing revenue when your physician has to reduce her services.
While the dreaded insufficient documentation denial is one of the most common when coding with modifier 52 (Reduced services), the exact type of notes you need to include depends on the answer to a single, simple question: Why didn’t the provider didn’t finish the service?
You can answer this question by meeting provider expectations for modifier 52 services. Providers will expect you to use modifier 52 properly in the correct situations; get ahead of the curve by knowing how to use modifier 52, and get the scoop on the documentation you need when filing these claims.
Background: According to CGS, you should use modifier 52 when:
Documentation: When submitting a modifier 52 code, CGS recommends that you: