Advanced Search

Radiology Coding Alert

READER QUESTION:

Be Careful With Modifier -22

Published on Sat Oct 09, 2004

Question: Would you provide us with any information you have regarding multiplanar diagnostic imaging in reference to CTs? Specifically, how should we properly document and use modifier -22 for additional reimbursement?

Florida Subscriber
 
Answer: Multiplanar diagnostic imaging does have its own code. Before you append modifier -22 (Unusual procedural services), make sure you are truly reporting an unusual procedure.

Multiplanar diagnostic imaging (MPDI) provides reconstructed oblique images to enhance the data produced by computed tomography (CT) scans. For MPDI, you use 76375 (Coronal, sagittal, multiplanar, oblique, 3-dimensional and/or holographic reconstruction of computed tomography, magnetic resonance imaging, or other tomographic modality). You also report the code for the original imaging procedure.

Don't: If you use modifier -22 too often, carriers will suspect you of looking for improper payment. Your CPT guidelines tell you that a report may be appropriate, and if you want to get reimbursed, it absolutely is. A proper modifier -22 claim can get you an additional 20 to 25 percent, but don't count on this modifier to bring you extra compensation. If you can find a more specific code to describe the rendered service, choose that rather than modifier -22.

If you choose to append modifier -22, submit both a paper claim and the procedure report or radiographic dictation that identifies the complicating factors that contributed to the extra time and effort spent on the procedure. You may even want to ask your radiologists to include a "Special Circumstances" section in their reports to make this information more accessible for the claims reviewer. The reviewer is probably not a medical professional, and he needs to see why he should pay you clearly spelled out. Have the doctor explain the typical procedure and compare it to what he actually did, including time, special instruments, and technique. If you don't have the proper documentation, it's really not worth your time to submit modifier -22.

You also need to check with your payers. Some want to see that there was at least 25 percent more time and effort than usual. Others don't recognize modifier -22 for separate reimbursement, regardless of the circumstances.

Other Articles in this issue of

Radiology Coding Alert

View All