# modifier 22 - How many polyp removals



## tpontillo (Apr 29, 2011)

How many polyp removals in a colonoscopy would be excessive to warrent the 22 modifer?


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## jgf-CPC (Apr 29, 2011)

I have read that if it takes more than the usual 20 minutes for more polyps or maybe a tortuous colon then you would append the 22 modifier using an example of 90 or 120 minutes. And remember it must have the proper documentation to prove this.

"A colonoscopy is performed on a patient with a tortuous colon. Instead of taking the usual 20 minutes to complete, the gastroenterologist spends 90 minutes navigating the scope through the twists and turns of the patients lower intestine. Modifier -22 (unusual procedural services) is attached to the colonoscopy procedure code when the claim is filed."


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## tpontillo (Apr 29, 2011)

Thank you.  I knew that there was a time involved but couldnt remember.  My office manager was asking me about 5 polyps but nothing was said in the report that more time was taken to remove them.   I told her I didnt think it warrented a 22 modifier but I wanted to double check.


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## DEDGE CGIC (May 13, 2011)

What cost differential do you apply when adding the 22 modifier as properly supported by the documentation?


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## jojogi (Jun 4, 2011)

According to the AGA coding manual, more than 10 polyps warrant the modifier 22


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## hollee.hamilton (Dec 19, 2011)

*modifier 22 in GI*

Would it be advised to add the modifier 22 to a colonoscopy that includes a polypectomy, injection to raise the polyp and used clips to stop the bleeding?


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## rcclary (Dec 27, 2011)

No it would not warrent the use of 22 modifier but you can charge for the polypectomy and the saline injection but you cannot bill for the endoclip to control bleeding.


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