Pathology/Lab Coding Alert

Question: I’ve been told we should use modifier 22 only if the pathologist documents at least 60 minutes of additional time to complete a procedure — is that correct?

Minnesota Subscriber

Answer: Additional time is one element that you should consider for determining if it’s appropriate to use modifier 22 (Increased procedural service), but time is not the only factor; plus, there is no hard and fast rule that you must document more than 60 minutes of extra time.

You should turn to modifier 22 to describe a procedure for which the pathologist documents that the work required is significantly more than is typical. The documentation should include evidence of why the additional work is medically required and how much extra work the procedure involves. This might include factors such as how large a specimen is, or how many more tissue blocks the pathologist must process and how much more complex the exam is than a typical service for the same code. The pathologist should also document time to perform the procedure relative to a typical case for the same service, but time alone isn’t the measure.

Coder tip: Payers will typically pay 20 percent more for modifier 22, so they may want to see 20 percent more effort for the procedure, whether that’s due to factors such as time, complexity, intensity, etc. For that reason, using percentages in the documentation can be helpful.