Otolaryngology Coding Alert

Question: Our surgeon completed a parathyroidectomy with frozen section and several rapid intact PTH labs. She did two at five minutes and two more at 10 minutes. Because of this, the surgery took a lot longer than expected. She wants to use modifier 22, but I’m not sure if it’s correct.  Can modifier 22 be used to cover wait time? 

California Subscriber

Answer: When you include modifier 22 (Increased procedural services) on a claim, it refers to additional work involved in the surgical procedure, not “waiting time.”  

Modifier explanation: According to CMS, “In order to append modifier 22 to a surgical procedure, check that the physician documented the reason(s) why the work he performed was more than he typically performs, and the documentation should include any or all of the following: 

• Increased intensity 

• Additional time 

• Technical difficulty 

• Severe patient condition, which causes the surgery to be difficult, dangerous to the patient, and requires additional physical and mental effort from the physician.”  

Had the extra time been a result of a complex case that required more biopsies than are usually taken and the documentation reflects this, the extra work and time taking the biopsies could be considered to qualify for the 25 modifier. But if the additional time was just a result of waiting for the pathology to come back, you might have a difficult time supporting modifier 22 for an increased service. Also keep in mind that the surgery needs to be at least 25 percent more complicated than usual in order to start qualifying for the 22 modifier. Any additional services that amount to less than 25 percent more than the average service would not have a 22 modifier added to it.