Pathology/Lab Coding Alert

Meet the new documentation rules head-on or risk denials If you use modifiers to report additional or unusual lab services, get ready for a new modifier and tougher restrictions on two existing modifiers to report your services in 2008. We-ll teach you how to hone your documentation skills for modifiers 59 and 22 and when to use new modifier 92 to make the most of your lab services. Pay close attention to the following three steps you should take to optimize your modifier use in 2008: 1. Tighten Your Modifier 22 Criteria CPT definition for modifier 22 has changed for 2008 -- from "Unusual procedural services" to "Increased procedural services" -- and so has the descriptor language in appendix A. What's the difference between "unusual" and "increased" in the modifier definition? Evidently the change is a clarification to help distinguish 22 from other modifiers, such as the "flip-side" modifier 52 (Reduced services). But the key change to 22 comes in the descriptor language that tells you how and when to use the modifier. Old rules: Prior to 2008, CPT instructed you to use modifier 22 when your physician provides a service that is "greater than that usually required for the listed procedure." A report on the reason for the modifier "may also be appropriate," according to CPT instruction. New rules: Starting Jan. 1, your physician's work must be "substantially greater than typically required." And your "documentation must support the substantial additional work." You must also list the reasons why the doctor had to work harder, such as increased intensity, time, technical difficulty of the procedure, severity of the patient's condition, or physical and mental effort required. The new language sounds a lot tougher than the old wording, but you-ll have to wait for guidance on what "substantially greater" means, says Barbara Cobuzzi, MBA, CPC, CPC-H, CHBME, director of outreach for the American Academy of Professional Coders (AAPC) in Salt Lake City. Some experts teach that you should use modifier 22 whenever the physician spends about 25 percent more time or effort than usual for a procedure. But Medicare may not consider 25 percent "substantially greater" than normal, Cobuzzi says. Document your increased pathology services: The new descriptor provides some great pointers on what you can document that "increases" your service -- intensity, time, difficulty, and physical or mental effort, for instance. "Repeated reviews by Medicare have shown that doctors are not supporting modifier 22 well enough in their documentation," says Dianne Wilkinson, RHIT, compliance officer and quality manager with MedSouth Healthcare in Dyersburg, Tenn. So the CPT update beefs up the documentation requirements to encourage you to do what you should already be doing, she adds. For example: Your pathologist [...]