Pulmonology Coding Alert
Append Modifier -22 for Primary Care Services
Florida Subscriber
Answer: You should append modifier -22 (Unusual procedural services) only to primary services that your pulmonologist considers unusually greater in time and effort than the typical procedure. To capture the increased time and effort, append modifier -22 to whichever code describes the rendered service. Carriers often require a manual review of the claim to ensure adequate reporting of the code. The written report should be sent along with all claims involving modifier -22. Make sure that the physician documents the extenuating circumstances that warrant use of modifier -22. For example, if the average procedure takes 20 minutes but because of an unexpected complication the procedure took 40 minutes to complete, the physician should describe the situation in detail and compare it to the average procedure, explaining the reasons why it was extended. You will also have to include a cover letter indicating the use of modifier -22 and the amount of additional reimbursement you would like to receive for the additional work.
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