Pediatric Coding Alert

HCFA has decided not to recognize modifier -60 (altered surgical field). The new surgical modifier, introduced in CPT Codes 2001, included a special provision allowing its use in any infant under 10 kg (22 pounds) and was to be used in place of modifier -22 (unusual procedural services) if a procedure involved significantly increased operative complexity and/or time due to the effects of prior surgery, marked scarring, adhesions, inflammation or distorted anatomy.

In a Dec. 21, 2000, transmittal (B-00-75), HCFA argued that unwarranted use of the modifier would become routine for a variety of procedures that are typically performed in infants (and already valued as being performed in an individual less than 10 kg.). In addition, the agency predicted modifier -60 claims would surpass the current number of modifier -22 claims and require increased medical review on the part of insurers, and claimed objective verification of the altered surgical field [is] difficult or impossible.

Until further notice, HCFA has instructed physicians to use modifier -22 for all unusual procedural services.

Although most private payers are likely to follow HCFAs lead, some may accept modifier -60 claims. Pediatric practices should check with their carriers to determine if a set value for the modifier has been determined or if its use requires case-by-case consideration, says Barbara Cobuzzi, MBA, CPC, CPC-H, a coding and reimbursement specialist and president of Cash Flow Solutions in Lakewood, N.J.

Whether coding with modifier -60 or modifier -22, better documentation will result in higher reimbursement, Cobuzzi advises. She reminds coders to ask for additional payment when filing a claim with either of these modifiers. Without a request for additional reimbursement, private payers are no more likely to boost payment for modifier -60 claims than for modifier -22 claims.