Oncology & Hematology Coding Alert

Question: How should I decide whether managing excessive bleeding that requires extra physician time and effort during a procedure warrants the use of modifier -22 or a critical care code?

Florida Subscriber

Answer: It's hard to determine whether to append modifier -22 (Unusual procedural services) to a code, report a critical care code, or report a separate CPT code when bleeding complicates a procedure - and careful review of the physician's documentation is vital.
 
First and foremost, you can forget about using modifier -22 if bleeding complicates an E/M service. Modifier -22 can only be appended to surgical CPT codes. Modifier -22 is most commonly used because of excessive bleeding when the bleeding is a direct result of the procedure the physician is performing.
 
Circumstances definitely exist in which a critical care code is a more appropriate choice for a control-of-bleeding situation rather than modifier -22. You may need to use a critical care code when the physician is controlling bleeding for a patient who is critically ill and whose condition is potentially life-threatening if the bleeding continues.
 
The CPT codes that specifically represent the control of bleeding during a procedure, e.g., 43255, typically only represent endoscopic techniques for treating bleeding such as application of cautery with heater probe or bipolar or monopolar probe, injection of vasoconstrictive or irritant liquids, or laser cautery. These control-of-bleeding codes should only be used when a wound is actively bleeding, otherwise you should consider using modifier -22. Control-of-bleeding codes also cannot be reported if the physician induces the bleeding during a procedure. According to Principles of CPT Coding, these codes "are intended to be used when treatment is required to control bleeding that occurs spontaneously, or as a result of traumatic injury (noniatrogenic), and not as a result of another type of operative intervention."