Ob-Gyn Coding Alert

Question: My understanding is that if a labor management procedure becomes difficult and the ob-gyn spent more time than usual with a particular patient, I can report modifier -22. Also I don't raise the fee. I expect to get reimbursed 30 percent more than what insurers usually pay for the procedure. Am I correct?


Texas Subscriber

  Answer: If you are reporting modifier -22 (Unusual procedural services), you need to raise your fee to let them know how much more your think you deserve.

Because the claim will then go to manual review, you may just get what you ask for. There is no set reimbursement for this. Each payer determines what they will pay, and sometimes it will be less than 20 percent, sometimes more than 30 percent, and of course sometimes nothing at all.

The issue with labor management is that you cannot pinpoint the "usual" time it takes a woman to deliver, because some are easy and some are hard. Certainly if the physician spent 10 hours with the patient and was precluded from doing anything else because of her condition, you would qualify for modifier -22.

However, if the ob-gyn spent only four and a half hours, the outcome of higher reimbursement is a little less certain.