Pulmonology Coding Alert

Extra effort, time are important, experts say.

Before sending that modifier 22 (Increased procedural services) claim out the door, make sure that your information-packed claim includes the following features.

Do Include These Factors

• A paragraph in your letter that clearly indicates why the procedure performed was substantially more involved than what the descriptor indicates. The payers will base your additional income on this information, so if you can include a percentage (such as “the procedure was 35 percent more difficult than a standard bronchoscopy,”) it’s wise to do so.
• A reason that the surgeon had to go over and above what the code descriptor describes. For instance, explain the increased intensity, time, difficulty of the surgery, severity of the patient’s condition, and/or physical/mental effort required.
• Specifics about how and why the procedure was more challenging than the standard, and be sure to compare the actual time, effort, or circumstances to those typically needed or encountered.
• Additional diagnoses, preexisting conditions, unexpected findings, or complicating factors that contributed to the extra time and effort spent performing the procedure.

Don’t Include These Factors

• Don’t append modifier 22 to an E/M code — only use it with procedure codes that have zero, 10-, or 90-day global periods.
• Don’t simply use general statements, like “patient was obese.” You must provide a significant amount of detail to justify the use of modifier 22, noting why the patient’s condition prompted a more challenging procedure than the standard.
• Don’t stop after just describing the additional time spent. Time alone does not typically justify the use of modifier 22.