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Question: Can I report additional work due to scarring from a previous surgery? Is there a modifier for this?
Rhode Island Subscriber
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Answer: For now, the best (and only) way to report additional physician effort as a result of scarring, alteration of landmarks or other complications of previous surgery is to append modifier -22 (Unusual procedural services) to the appropriate CPT code.
CPT introduced a new modifier in 2001 (modifier -60) to indicate an altered surgical field. At that time, the AMA changed the descriptor for modifier -22 to state, "This modifier is not to be used to report procedure(s) complicated by adhesion formation, scarring, and/or alteration of normal landmarks due to late effects of prior surgery, irradiation, injection, very low weight (i.e., neonates and infants less than 10 kg) or trauma." In a Dec. 21, 2000, transmittal (B-00-75), however, CMS refused to recognize modifier -60, arguing that it was unnecessary and a potential source of abuse. Specifically, CMS worried that physicians would add modifier -60 "to procedures such as revisions of total hip arthroplasty" (27134-27138) even though the appropriate CPT codes include the additional work necessary to perform the revision." With that decision, modifier -22 again became appropriate to report all unusual procedural services, and the AMA eliminated modifier -60 from CPT the following year.
The December 2000 CMS decision raises an important point, however. When reporting procedures specifically defined as revisions or re-explorations (for example, laminotomy, 63040-63044), remember that CMS considered an altered surgical field when the agency valued the code. Therefore, do not append modifier -22 automatically except in unusual revision circumstances when the scarring or altered field greatly increases the time and work typically involved in such a repeat procedure.
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