General Surgery Coding Alert

Question: We did a below-knee amputation on a patient. The operative report states that the total tourniquet time was 1 hour and 40 minutes. Would this justify a modifier or is this considered normal?

North Carolina Subscriber  
Answer: Without knowing all the circumstances in this case, it is difficult to give a definitive answer. The only modifier that might apply is modifier -22 (unusual procedural services). But, it seems unlikely that modifier -22 could be appropriately appended. When surgeons use a tourniquet to perform an amputation, tourniquet time is recorded as a matter of course for liability purposes. The real question here is: How long does it normally take for this surgeon to perform this type of procedure? If the surgery was complicated because of unusual circumstances, there might be a case for appending modifier -22, assuming the documentation supported the claim by clearly indicating why the procedure was more difficult than usual and noting the additional time and work involved. If the surgeon did not do significant additional work, there is no basis for appending modifier -22 to the claim.