General Surgery Coding Alert

"Increased" circumstances that might call for modifier 22 include (but are not limited to):

- excessive blood loss for the particular procedure

- presence of excessively large surgical specimen (especially in abdominal surgery)

- trauma extensive enough to complicate the particular procedure and not billed as additional procedure codes

- other pathologies, tumors, malformations (genetic, traumatic, surgical) that directly interfere with the procedure but are not billed separately

- services rendered that are significantly more complex than described by the CPT code in question.

Additional circumstances that might (but not necessarily) merit modifier 22 include morbid obesity, low birth weight, conversion of a procedure from laparoscopic to open, significant scarring or adhesions, or when the surgeon performs services that are usually bundled (like lysis of adhesions, control of bleeding, lavage, exploration, etc.) but require substantially greater time and/or effort.