General Surgery Coding Alert

Question: If the physician spends an additional 30 minutes lysing adhesions during a laparoscopic chole-cystectomy, may I append modifier -22?

Illinois Subscriber

Answer: CPT guidelines for using modifier -22 (Unusual procedural services) are maddeningly imprecise, stating only, "When the service(s) provided is greater than that usually required for the listed procedure, it may be identified by adding modifier -22." Remember that relative value levels for CPT codes are based on the median level of difficulty for a given procedure. That is, the time and work required for any procedure will vary from instance to instance, but payment remains constant on the assumption that the "hard" and "easy" instances will balance one another over time.

To apply modifier -22, you must determine if the difficulty of the procedure falls outside the level of difficulty you might reasonably expect to see for a procedure of that type. Most coding professionals suggest that you must spend at least 25-30 percent additional time and/or effort on a procedure to report modifier -22.

In this case, an additional 30 minutes to complete a laparoscopic cholecystectomy (which may normally require 30 minutes to an hour to complete) because of adhesions is substantial enough to warrant additional compensation. Simply attaching modifier -22 to 47562 (Laparoscopy, surgical; cholecystectomy), however, will not increase your payment. You must specifically request additional payment. Attach a cover letter with the claim stating, for instance, "Due to additional time and effort, we are requesting an additional 25 percent compensation for this procedure."