Wiki Question if documentation meets Modifier 22

[tblmt1966]

I would like through regarding adding Modifier 22 to 58571? I feel this does not warrant the use of modifier 22 as the provider stated significant and not excessive. On the statement and approximately 20 minutes of adhesiolysis was preformed to visualize the ante part of the uterus and to develop the bladder flap. I do not that statement warrants for use of modifier 22 either. As it's not clear as how much additional time was exactly used for the removal of adhesions.

An anterior adhesion to the omentum was taken down using the Vessel sealer. There were significant adhesions from the uterus to the peritoneum as well. First, the fallopian tubes were grasped at their distal end and elevated. Adhesions were taken down around the right adnexa. The Vessel sealer was used to divide the mesosalpinx separating the tube from its underlying ovary. The utero-ovarian ligaments were isolated bilaterally, bipolar cauterized and divided. The round ligaments were bipolar cauterized and divided, and approximately 20 minutes of adhesiolysis was performed to visualize the anterior part of the uterus and to develop the bladder flap. The ureters were visualized bilaterally. The anterior cul-de-sac was developed, taking bladder off the lower uterine segment. The posterior leaf of the broad ligament was divided bilaterally. Uterine vessels were skeletonized, then Vessel sealer used to cauterize and divide bilaterally. Proximal and distal cardinal ligaments were bipolar cauterized and divided. A posterior colpotomy was created on the V-ring. It was carried 360 degrees circumferentially, releasing cervix from vagina. Uterus, cervix and bilateral fallopian tubes were removed through the vagina.

 

[nielynco]

Under Medicare rules:
Documentation must support the substantial additional work and the reason for the additional work such as:

Increased intensity
Time
Technical difficulty of procedure
Severity of patient’s condition
Physical and mental effort required.

I don't see this documented in the note above and would agree that if you do report the 22 modifier, you will get a denial for the extra work. Time alone without also describing the nature of the adhesions and why they needed to be take down will not usually pass muster with the payer.