Reader Question:
Prove Extra Effort When Reporting Difficult Vitrectomy
Published on Fri Apr 23, 2004
Question: How can we get paid more for a vitrectomy with membrane peeling, especially when it is a difficult case?
South Carolina Subscriber Answer: The code for vitrectomy with membrane peeling is 67038 (Vitrectomy, mechanical, pars plana approach; with epiretinal membrane stripping). Some of these procedures go on for five hours, and you would be justified in adding modifier -22 (Unusual procedural services). But that doesn't necessarily mean you will be paid extra. Unless you use a lot of special techniques, spend a long time and perform a procedure that is truly difficult, you don't merit additional payment.
The key to reimbursement for this service is the operative note. Modifier -22 will require that you send your claim by paper with additional documentation. You will need to provide the operative report and a cover letter explaining why the procedure was more extensive, and the claim will have to go through review. Be prepared to be patient.
-- Answers to Reader Questions and You Be The Coder were contributed by Raequell Duran, president of Practice Solutions in Santa Barbara, Calif.
