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 [...]