Gastroenterology Coding Alert

Before sending that modifier 22 claim out the door, take a quick look to be sure you-ve followed this list of do's and don-ts:

--Do be sure that the physician required at least one-third (33 percent) more time/effort than usual to perform the procedure.

For procedures that normally do not require a great deal of time or effort to complete (for instance, diagnostic colonoscopy 45378, Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]), you may have to show that the physician required more than twice the usual time/effort to claim modifier 22.

--Do include full documentation, including any complicating diagnoses, with your claim.

--Do attach a cover letter describing the unusual nature of the procedure and specifically request additional compensation from the payer.

--Don-t use modifier 22 for E/M visits.

--Don't use modifier 22 if a separate CPT code or critical care service better describes the circumstances (see -Consider Control of Bleeding Code Carefully-  later in this issue for more information).