Modifier 22 Moves for Ob-Gyn Coders

Posted on 22. Jul, 2009 by Editor in Hot Coding Topics

This U/S tactic will save you time — and add money to your bottom line.

Appending modifier 22 (Increased procedural services) may be something you think you’ve got down pat, but that doesn’t mean your ob-gyn coding will always be error-proof.

Review the following three frequently asked modifier 22 questions — answered by our ob-gyn coding experts —  and discover solid advice on how much longer a procedure should take to append modifier 22, if you can use an unlisted procedure code instead, and whether you have regular CPT code alternatives.

Service Should Take 25 Percent More Than Usual

Question: How much longer should the procedure take in order for me to bill modifier 22?

Answer: Some experts suggest that you shouldn’t use modifier 22 unless the procedure takes at least twice as long as usual. Several memorandums from Medicare carriers indicate that time is an important factor when deciding to use this modifier. “The additional time and work must be significant,” says Gayle C. Mack, CPC, Maternal Fetal Medicine coder at Spectrum Health in Grand Rapids, Mich. Rule: A procedure should take at least 25 percent more time and effort than usual.

Time is quantifiable, allowing a carrier to more easily convert the extra work into additional reimbursement. For example, statements such as “50 percent more time than usual was required to excise the lesion because of the patient’s obesity, making the total procedure 45 minutes instead of 30 minutes” can be very effective.

Explain why: “When I’m working with my physicians, I always stress that just documenting the additional time is not enough; you have to explain why it took more time and what the additional work entailed,” says Angela Jordan, CPC, manager of coding and compliance at Women’s Healthcare Network in Lenexa, Kansas....

Tags: 76830, 76856, modifier 22, modifier 51, ob-gyn, time, unlisted code