Consider -22 for Services Beyond CPT's Scope of Work
Published on Wed Jun 08, 2005
Tally the value of your physician's extra work for unusual procedures When your pulmonologist performs services that are more difficult than other procedures and take more time to complete, carefully consider modifier -22 (Unusual procedural services) because it may or may not be the answer. Test your knowledge here by answering the following questions before checking the answers to see if you know what constitutes an unusual procedure. Question 1: If a procedure takes more time or effort because it's the first time the pulmonologist performs the procedure, you should append modifier -22 to the procedure code.
TRUE OR FALSE Question 2: The physician attempts to remove a foreign body in the patient's pleural cavity. He begins the procedure by using the thorascope (32653), but due to difficulties, he must abandon the scope and remove the foreign body via thoracotomy (32150). In this scenario, you should report 32653 and 32150.
TRUE OR FALSE Question 3: Modifier -22 entitles you to an additional 30 percent of the procedure fee.
TRUE OR FALSE Answers Answer 1: False
Just because a procedure is more difficult for a pulmonologist to complete, you can't automatically justify modifier -22.
You should append modifier -22 to notify your payer that your pulmonologist completed a complicated, complex, difficult procedure that may have taken him more time than usual, says Michele Wendling, billing manager for Midwest Medical Service in Troy, Ohio.
CMS guidelines stipulate that modifier -22 indicates "an increment of work ... infrequently encountered with a particular procedure" and not described by another code. Therefore, you should append modifier -22 only to select cases when the work your pulmonologist completes surpasses the normal amount of work, Wendling says.
Increased procedure time due to lack of physician skill or to deal with a complication that is a known and expected outcome does not warrant appending modifier -22 either, Wendling says.
To justify using modifier -22, you should identify a truly unique condition about the specific patient, such as a scarred surgical site or abnormal anatomy, that causes additional work above and beyond what the physician expects, even considering potential complications.
Example: Your pulmonologist spends more time than usual dealing with excessive blood loss while inserting a bronchoscope for diagnostic purposes (31622, Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing [separate procedure]).
You may append modifier -22 to 31622 if the blood loss and physician care time are excessive and the pulmonologist properly documents them.
Don't miss: The pulmonologist should document the methods he used to control the blood loss and how much extra time he spent inserting the catheter, as well as the underlying co-morbidity that caused the additional work, Wendling says.
Exception: You should not append modifier -22 if an error by [...]
