Wiki Lysis of Adhesions, extensive

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Tracierey

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I have a general surgeon who performed an extensive lysis of adhesions, over 2 hrs. Total operative time 5 hours and he wants to know if we can bill for the extra time due to the patient's adhesions and morbid obesity. He also performed a partial colectomy. Can we add a modifier to these procedures since they took quite a bit longer, or are we not able to bill for the extra time that this involved? Any suggestions?
Thanks!
 
Review the description of Modifier 22 in your CPT book and if use of that modifier is supported by your physician's documentation, go with it.
 
Yes the 22 modifier is the one to use. As long as the docuemntation supports extensive nature of the procedure. If the physician states morbid obesity then it is advisable that the BMI be documented and add that V code. Also do not use the code for the adhesiolysis, code the main procedures and append the 22.
 
mitchellde said:
Yes the 22 modifier is the one to use. As long as the docuemntation supports extensive nature of the procedure. If the physician states morbid obesity then it is advisable that the BMI be documented and add that V code. Also do not use the code for the adhesiolysis, code the main procedures and append the 22.
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When using modifier 22 - should the amount for this procedure be increased above what is normally charged?
 
No I always do this in my cover letter where I explain why a 22 was appended and then request a 30% increase ove the usual amout. I have never been disappointed. You do need a great cover letter, spell it all out for them, do the review you expect them to do with your cover letter.
 
22 modifier

We DO increase our fee by (usually) 25% when we add the -22 modifier.

I absolutely agree with Debra that you need a good letter of explanation as to why you are requesting the additional monies.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
We too increase our charge when billing the -22 modifier and submit claims with a coverletter, medical rationale and industry (NCCI)guidelines/specialty billing guidelines or payer billing guidelines to support increased payment.

Julie, CPC
 
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Here's an example:
Following is additional information on a claim for the above patient. The operative report for the surgery is enclosed. This was a very complex surgery and the claim was not paid for the level of service performed. There were significant ureteral adhesions to the right adnexa. An extensive ureterolysis was required prior to the oophorectomy. The additional work required for this case resulted in an additional 1 hour of surgery time. In light of the additional services beyond the total hysterectomy and the complexity of the hysterectomy, an additional 25% payment should be made. Please review the information and have the claim reconsidered for payment. Please contact me immediately with any questions or problems. I can be reached by phone at (###) ###-#### or via e-mail email@email.com. I thank you in advance for your time and consideration.

Obviously if the additional work was more or less comprehensive than in this particular case, I would increase or decrease the additional percent requested accordingly. I very, very, very rarely write in-depth coverletters. I state in a few sentences what took place, what I am asking for, and let the operative report do the rest.
 
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