Orthopedic Coding Alert

Note re -22 Modifier for Unusual Procedural Services: A –22 Modifier was added for Unusual Procedural Services due to the difficulty and complexity of the case, which involved revision surgery through an altered surgical field. The additional time necessary to complete the procedure, compared to a standard procedure of this type, was 0 hours 30 minutes. The patient’s previous incision from the prior surgery was noted. It was also used for this case.

RE: Omar McDickle
TOA Record #: 99999
SS #: 999-99-9999

Dear Medical Director,

Attached is a copy of my operative report and bill for the above-mentioned patient. This procedure was more technically demanding and time consuming than that described by the CPT^® Code(s): 23420.

Code 23420 describes a primary procedure and Mr. McDickle underwent revision surgery. His original surgery(ies) were performed in January 2004. The pre-operative and post-operative work performed is about the same for the primary and the revision surgery.

The surgery done on Mr. McDickle, however, involved intra-operative work that was much more extensive. Notably:

Operating through an altered surgical field, due to the previous surgery.
Increased operative time of approximately 0 hours 45 minutes.

Significant dissection of scar tissue from the previous surgery necessitated careful dissection, with neurovascular structures close to the operative field.

I estimate that the above factors make this procedure approximately 25% more difficult than that described by code 23420; therefore, I am asking a 25% increase in my normal fee for this procedure.

If you have any questions, please feel free to contact me. Thank you so much for your time.

Sincerely,
Joe Smith, MD