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 ...
In CMS
Jul 18th, 2014
Medicare rules for treating complications during the postoperative period differ from CPT® guidelines. Specifically, to separately report treatment of complications to Medicare payers, that treatment must meet one of two conditions: 1. If the provider treats the complication during the initial procedure, the complication must entail treatment demonstrably in excess of that usually required for ...
“When applied properly, modifier 22 “unusual procedural service,” allows a provider to recover reimbursement above and beyond the regular payment for a difficult or time-consuming procedure,” wrote G. John Verhovshek, MA, CPC AAPC’s Director of Editorial Development, in the most recent California Medical Associations’ CMA Practice Resources. He continued, &#...
Dec 6th, 2011
Due to the constant complexity of coding, modifiers are a key component in the industry. AAPC’s director of curriculum, Katherine Abel, CPC, CPMA, CEMC, CPC-I, highlights several modifiers in the most recent CMA Today. She highlights the three most commonly misunderstood modifiers, 25, 59, and 22. “Modifier 25 indicates a service is a significant, separately ...