Ob-Gyn Coding Alert

If your ob-gyn repairs a third- or fourth-degree laceration, don't be afraid to attach modifier 22 (Increased procedural services) to your ob global package (such as 59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care). In that situation, ask for extra reimbursement for the extra work.

Keep in mind: CPT 2008 changed modifier 22's descriptor. What this means: You should apply modifier 22 only when documentation supports the need for considerable additional physician time or effort. You should list the reasons for the additional effort when submitting your claim. To say that a procedure deserves modifier 22 because it was "unusual" has never been true. What matters (and has always mattered) is that the procedure must require substantially greater physician effort or time to complete.

"Repeated reviews by Medicare have shown that doctors are not supporting modifier 22 well enough in their documentation," says Dianne Wilkinson, RHIT, compliance officer and quality manager with MedSouth Healthcare in Dyersburg, Tenn. So the CPT update is beefing up the documentation requirements to encourage you to do what you should already be doing, she adds.

To learn how to substantiate your modifier 22 claims, attend The Coding Institute's 2008 Pediatric, Ob-Gyn and Urology Coding and Reimbursement Conference on May 15-17 in Naples, Fla., or July 10-12 in Las Vegas. For more information, go to http://www.codingconferences.com.