Radiology Coding Alert

Question: The radiologist uses neck ultrasound (76536) to image lymph nodes for staging. She says it requires a lot of additional time and work to measure the nodes. May I append modifier 22 in this situation? Massachusetts Subscriber Answer: Private payer rules may vary, but for Medicare, you should not append modifier 22 (Increased procedural services) to 76536 (Ultrasound, soft tissues ofhead and neck [e.g., thyroid, parathyroid, parotid], real time with image documentation). Reason: You should append modifier 22 only to "procedure codes that have a global period of 0, 10, or 90 days," states the Medicare Claims Processing Manual, Chapter 12, Section 40.2.A.10 (www.cms.hhs.gov/Manuals). The Medicare physician fee schedule shows "XXX" for 76536, which means the global concept doesn't apply. The XXX designation is typical for diagnostic exams. If a payer does allow modifier 22, CPT specifically recommends that physicians document the reason for the additional effort, such [...]