Neurosurgery Coding Alert

Coding for complicated surgeries doesn't automatically lead to appending modifier 22 (Increased procedural services), but you should always be on the lookout for potential uses. Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-I, CCC, COBGC, manager of compliance education for the University of Washington physicians compliance program, shares a few examples of situations that might call for modifier 22 (though you're not limited to these scenarios):

• Reoperations or operations that go through areas where the patient had previous surgery.

• Presence of excessively large surgical specimen (especially in tumor surgery).

• Unusual bleeding. "Control of bleeding cannot be billed separately, but unusual bleeding can become a nightmare to control," Bucknam notes.

• Extensive trauma (especially if your physician specializes in nerve reconstruction or spine surgery).

• Patients who cannot cooperate with care (such as those with epilepsy, tremors, or altered mental status).

• Services rendered that are significantly more complex than those described for the CPT code in question.