General Surgery Coding Alert

Question: If the surgeon states a large area was debrided and the debridement codes are relative to depth, how do you determine if the area size justifies modifier 22?

Louisiana Subscriber

Answer: Payers will not likely view a statement that surgeon debrided a large area (or even that he debrided over ____ cm2 of tissue) as sufficient documentation to secure additional reimbursement for the debridement procedure using modifier 22 (Increased procedural services).

Most coders have found that in order to get additional reimbursement for modifier 22 the physician must describe additional time--for example, "twice as much time as normal" or "an additional three hours"--or must  describe a percentage of additional difficulty, such as "twice as complex as normal" or "150 percent more effort than usual."

However, the rule of thumb is the physician must spend at least 50 percent more time and/or put in at least 50 percent more effort than normal for you to append modifier 22. So logically, in theory, if you wanted to use size of a debridement to justify using modifier 22 the size would need to be 50 percent larger than "normal" with normal being relatively undefined.

Best bet: Check with your payer to see if it allows you to use modifier 22 based on the debridement size.