Modifier -60 Gets Payment for Work on Altered Surgical Field
Published on Fri Dec 01, 2000
CPT 2001s new modifier -60 could be good news for chest surgeons and their coders. Until now, coders billed any procedure that was complex and required additional work with modifier -22 (unusual procedural service). As of Jan. 1, 2001, however, if the procedure is more complex because the doctor has encountered an altered surgical field, CPT instructs surgeons to use modifier -60:
Altered Surgical Field: Certain procedures involve significantly increased operative complexity and/or time in a significantly altered surgical field resulting from the effects of prior surgery, marked scarring, adhesions, inflammation or distorted anatomy, irradiation, infection, very low weight (i.e., neonates and small infants less than 10 kg) and/or trauma (as documented in the patients medical record). These circumstances should be reported by adding the -60 modifier to the procedure number or by use of the separate five-digit modifier code 09960.
Many coding specialists like this new modifier because it clarifies why the work was more complicated and/or took more time, and it can result in additional payment. Now its up to Medicare and other carriers to announce documentation and reimbursement criteria for using the modifier.
Meanwhile, pulmonary physicians and their coders must distinguish between complicated procedures requiring modifier -60 and those that modifier -22 still cover.
The description of modifier -60 includes this note:
For unusual procedural services not involving an altered surgical field due to the late effects of previous surgery, irradiation, infection, very low weight (i.e., neonates and infants less than 10 kg) and/or trauma, append the modifier -22 or use the separate five-digit code 09922.
Modifier -22s description also has been amended. It now says:
When the service(s) provided is greater than that usually required for the listed procedure, it may be identified by adding modifier -22 to the usual procedure number or by the use of the separate five-digit modifier 09922. A report may also be appropriate. Note: This modifier is not to be used to report procedure(s) complicated by adhesion formation, scarring, and/or alteration of normal landmarks due to late effects of prior surgery, irradiation, infection, very low weight ... or trauma (see modifier -60 as appropriate).
What is an Altered Surgical Field?
As of Jan. 1, 2001, when a pulmonary physician performs a procedure that requires more work and/or more time, coders will need to choose the correct modifier to ensure additional payment. To do so, coders need to understand what an altered surgical field is and what it isnt.
The surgical field is the site where the operation is performed. Usually, surgeons encounter a normal surgical field, which means there does not appear to be anything impeding the surgeons access to the object of the procedure.
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