General Surgery Coding Alert

Question: Is it correct that we should use modifier 22 only if the surgeon documents at least 60 minutes of additional time to complete the procedure, or is some other criteria the key to using modifier 22?

Massachusetts Subscriber

Answer: Additional time is one element that you should consider for determining if it’s appropriate to use modifier 22 (Increased procedural service), but time is not the only factor; plus, there is no hard and fast rule that you must document more than 60 minutes of extra time. Also, remember that should never append modifier 22 to an E/M service code.

You should turn to modifier 22 to describe a procedure for which the surgeon documents that the work required is significantly more than is typical. The documentation should include evidence of why the additional work is medically required and how much extra work the procedure involves. This might include factors such as how severe the patient’s condition is or increased intensity or difficulty in performing the procedure due to obstacles such as abnormally dense adhesions. The surgeon should also document time to perform the procedure relative to a typical case for the same service, but time alone isn’t the measure. Instead, the physician must document the factors that increased the required time, such as excessive bleeding or unusual internal circumstances that increased technical difficulty and increased mental and physical effort for the physician.

Coder tip: Payers will typically pay 20 percent more for modifier 22, so they may want to see 20 percent more effort for the procedure, whether that’s due to factors such as time, complexity, intensity, etc. For that reason, using percentages in the documentation can be helpful.