Neurosurgery Coding Alert

To argue more effectively that a claim was truly unusual -- and therefore deserving of modifier 22 and the additional reimbursement that comes with it -- you-ll want the claim's documentation to be as specific as possible. As such, you-ll want to consider as many of the following factors as possible:

- Time: Time is quantifiable, making it easier for a carrier to convert into additional reimbursement.

Example: Statements such as "200 percent more time than usual was required to excise the lesion because of the patient's obesity, making the total procedure 90 minutes instead of 30 minutes" can be very effective.

- Blood loss: Document the quantity of blood lost during the procedure, and compare it to what the typical patient loses during the same type of procedure.

Example: Include statements like "1,000 cc of blood, rather than the standard 100 cc of blood, were lost during the procedure." Then further explain why and what measures were taken to control it.

- Special instruments: Compare the instruments and equipment used to perform the procedure to those typically used (if different).

- Technique: Clearly indicate when there has been a change in technique during the procedure and, more important, why.

Example: "Due to extensive adhesions, the physician had to convert the laparoscopic procedure to an open procedure."

Hint: Avoid medical jargon and state clearly the reason for the surgery's "increased" nature. Encourage your surgeon to translate what went on in the operating room into easy-to-interpret language.