Wiki Modifier 53 with 22?

[talitha82]

I have a case for hardware removal, in which the physician tried unsuccessfully to remove a screw in a patient's leg. He worked on it for over 3 hours and attempted several different things to try to get screw out. Since he was unsuccessful in removing the screw, I feel like I should code this with a modifier 53- however I also feel we should be reimbursed for the extensive amount of time and effort he spent trying to remove it. Can I code this with a 53 AND a 22? I have searched high and low to find an answer on whether these can be billed together, and I just can't find anything. Thanks!

 

[emcee101]

I would not report this with modifier 53, which is used for procedures that are terminated "due to extenuating circumstances or those that threaten the well being of the patient".

If you choose to use one a better modifier would be 52 - reduced services - but I think that since the intent was to finish the complete procedure and the reason that the hardware could not be removed is beyond the patient's or physician's control you should not have to use a modifier.

I almost always advise against modifier 22. It does have a purpose, but often the cost of the administrative work that is involved in order to get an increase in reimbursement is greater than the actual increase. If you choose to use it, make sure that your documentation more than supports the substantial extra work that was done.

I've never seen/heard of a case where both modifiers, 22 and 52, were used together. I would love to hear of someone's experience with this and how they were reimbursed.

 

[twizzle]

I would not report this with modifier 53, which is used for procedures that are terminated "due to extenuating circumstances or those that threaten the well being of the patient".

If you choose to use one a better modifier would be 52 - reduced services - but I think that since the intent was to finish the complete procedure and the reason that the hardware could not be removed is beyond the patient's or physician's control you should not have to use a modifier.

I almost always advise against modifier 22. It does have a purpose, but often the cost of the administrative work that is involved in order to get an increase in reimbursement is greater than the actual increase. If you choose to use it, make sure that your documentation more than supports the substantial extra work that was done.

I've never seen/heard of a case where both modifiers, 22 and 52, were used together. I would love to hear of someone's experience with this and how they were reimbursed.

Have to agree with emcee101 in that mod 52 is the one to use. Although using 22 and 52 together might seem a little strange, modifiers are there to explain "unusual " situations. Yes, modifier 22 is notoriously difficult to get paid but, providing the documentation is good (because records will need to be submitted), it does happen. Add 15% to the usual charge. Your provider did the work and he/she deserves to get paid for it...wow, 3 hours though.