Radiology Coding Alert

Backing up your use of modifier 22 has never been a walk in the park, but in 2008 you may have an even harder time.

2007: You use modifier 22 (Unusual procedural services) when your physician provides a service that is "greater than that usually required for the listed procedure." A report on the reason for the modifier "may also be appropriate."

2008: The new descriptor does offer some pointers on things to look for when you audit your use of modifier 22 (Increased procedural services), says Dianne Wilkinson, RHIT, compliance officer and quality manager with MedSouth Healthcare in Dyersburg, Tenn.

Your physician's work must be "substantially greater than typically required." And your documentation must support the "substantial additional work." You must also list the reasons why the doctor had to work harder, such as increased intensity, time, technical difficulty of the procedure, severity of the patient's condition, or physical and mental effort required.

The revised definition emphasizes increased physician work, not increased practice expense.

The new language sounds a lot tougher than the old wording, but you'll have to wait for guidance on what "substantially greater" means, says Barbara Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CHCC, director of outreach for the American Academy of Professional Coders in Salt Lake City.

Currently, experts teach that you should use modifier 22 whenever the physician spends about 25 percent more time or effort than usual for a procedure. But Medicare may not consider 25 percent "substantially greater" than normal, Cobuzzi says.

"Repeated reviews by Medicare have shown that doctors are not supporting modifier 22 well enough in their documentation," Wilkinson says. So the CPT update is beefing up the documentation requirements to encourage you to do what you should already be doing, she adds.