In Coding
May 5th, 2017
AMA’s Instructions for Use of the CPT® Codebook tell us, “do not select a CPT code that merely approximates the service provided. If no such specific code exists, then report the service using he appropriate unlisted procedure or service code.” The Instructions further note, “Each of these unlisted procedural code numbers (with the appropriate accompanying ...
In Billing
May 27th, 2016
Occasionally, a surgeon will attempt to perform a procedure using an approach that fails, and must the complete the procedure using a different approach or technique. When this occurs, you should code only for the successful approach. The National Correct Coding Initiative (chapter 1, “General Correct Coding Policies for National Correct Coding Initiative Policy Manual ...
When work is substantially greater than typically required, document it, and call on 22. Most surgical specialty practices are familiar with the documentation needed to report modifier 22 Increased procedural services. What has never been satisfactorily quantified for surgeons is the financial impact, from claim to claim, of applying the modifier. With a little help ...
In Billing
Sep 15th, 2015
by John Verhovshek, MA, CPC Difficulty alone doesn’t justify appending modifier 22 Increased procedural services. The procedure must be unusually difficult in relation to other procedures of the same type. The values assigned to CPT® codes assume an “average” service. Only rare, outlying cases—those that are far beyond the average difficulty—call for modifier 22. The ...
In Coding
Oct 15th, 2014
Robotic surgery is covered by routine and customary laparoscopic CPT® and ICD-9-CM coding practices, existing medical policies for advanced laparoscopic surgery, and current payer contract rates. The primary surgical procedure remains laparoscopic: You should not report unlisted procedure codes or modifier 22 Increased procedural services for robotic assistance (except perhaps, for instance, there ...