ED Coding and Reimbursement Alert

Question: CPT 2009s inside cover states that the definition for modifier 22 is Unusual procedural services. Has the AMA changed the definition of this modifier?

South Carolina Subscriber

Answer: The definition of modifier 22 should not be Unusual procedural services. In 2008, the modifier  descriptor was changed to Increased procedural services.

However, the change didnt make it to the inside cover and was corrected with an AMA Corrections Document.

Example: A special-needs patient who is very large and muscular presents to the ED with a cut on his right forearm. The ED physician performs a simple 6.5 cm repair. Due to the patients size and lack of cooperation, the physician must start and stop the procedure several times. Overall repair time is 45 minutes.

This might be a modifier 22 scenario, as it would not normally take 45 minutes to perform 12002 (Simple repair of wounds of scalp, neck, axillae, external genitalia, trunk, and/or extremities [including hands and feet]; 2.6 cm to 7.5 cm). Most payers have very stringent modifier 22 criteria, however, especially in the ED setting. So check your contracts or contact a rep if you have any doubts about the carriers rules.

Helpful tip: When you scan the PDF of errata, keep your CPT 2009 manual handy and mark all of the updates and corrections directly in your manual. That way, you are certain to be working with the most up-to-date information when youre coding procedures and wont have to continually refer back to the document.