Wiki Modifier 22 - exactly when can you add modifier

[OPENSHAW]

Modifier 22

exactly when can you add modifier 22. One of our physician's did a case on a patient and performed a selective coronary arteriogram, thoracic aortogram, and percutaneous transluminal coronary angioplasty stent. The patient see's another physician at our practice but another physician had to perform the procedure. The patient was not his patient; therefore, he had to consult with the other doctor (the patient's doctor) for information regarding the patient. The doctor's work at the same practice. The case was a little more complex in a lot more time was spent in performing the case.
Can our doctor bill for modifier 22 and should the doctor mention in the op report that he had to consult with another doctor prior to performing the case or is this even considered? Who determines how long a case normally takes. Some cases are complex and you have to run the wire thru several times even numerous times and this could take a lot longer. Some cases are difficult in passing the wire, and example might be the patient already has a stent and metal is already there and now you are doing another stent trying to pass the existing one. Who determines the time for a procedure or is there anything out there stating this code should take this long normally.
If a patient has cardiac arrest during the procedure and the procedure took longer, you can use modifier 22 in justifying how much longer did the procedure take and why did the procedure take longer.

Can someone please help me in the use of modifier 22 and what should be documented in using this modifier. Is there anywhere to get time components for cpt codes?

Thank you very much!!!!!!

 

[Kisalyn]

If there is a guideline somewhere, I'd be interested in knowing this information as well.

We mostly do routine colons and EGDs. I depend on our doctor's dictation and his description of the procedure on whether it seems prolonged or unusual in some way. Most of our physicians are educated on how to inform us that a procedure deserves the modifier 22. They will include a concise statement that includes time, mental effort, complexity and other complications. One of my physicians is really good at documenting for modifier 22 and always includes a comparative statement (Prolonged procedure due to multiple techniques lasting 70 minutes compared to a normal enteroscopy lasting 30 minutes.) If there is any question that one case may justify this modifier, I send the dictation back and query the physician and he can amend if warranted.

I have an old article that describes how to document well so the insurance will pay extra reimbursement. I know the description of modifier 22 has changed since then.

It states "First and foremost, modifier 22 is appropriate only to describe a truly 'unusual' procedure. One might argue convincingly that every brain surgery is difficult, for instance, but not every brain surgery is unusally difficult.... only those surgeris for which services performed are significantly greater than usually required justify the use of modifier 22, according to CMS regulations (Medicare Carriers Manual section 4822, A.10). AMA guideliens, as set forth in Appendix A of the CPT Manual...'when the work required to provide a service is substantially greater than typically required."

Our providers consult one another often, but we don't charge for that. I don't think you can since each provider in our group is considered one entity.