Pulmonology Coding Alert

Question: I have appended modifier 22 (Increased procedural services) to some recent difficult procedures on behalf of my pulmonologist and I have received denials for the majority of cases. I am wondering if I should take the time to appeal. Can you explain when I am allowed to use this modifier? Oregon Subscriber Answer: To be sure you are appending modifier 22 appropriately, you must know what constitutes unusual services. A range of smooth and more difficult tries at the same procedure are expected, so the pulmonologist must document that the service required significant additional time or effort that falls outside the range of services described by a particular CPT code to append modifier 22. Truly unusual circumstances will occur in only a minority of cases. CMS guidelines stipulate that you should apply modifier 22 to indicate an increment of work infrequently encountered with a particular procedure and not described [...]