Cardiology Coding Alert

Make a point of checking payment to see if you need to take action.

If you're coding for a Part B patient in one of Noridian's 10 states, keep that payer's rule for modifier 22 claims in mind.

Noridian Administrative Services (NAS) no longer requests additional documentation on codes with modifier 22 (Increased procedural services) appended. You'll have to ask for a redetermination if after NAS pays the claim your practice feels the service deserves higher reimbursement.

You must include the op report, a letter, or a "Modifier 22 Explanation Form" with your redetermination request, NAS advises providers. The point is to explain succinctly why the service deserves extra pay by demonstrating that the claimed service took significantly more time and effort than a typical case. Draw clear comparisons between the claimed case and a typical case to support your request, such as, "The procedure required 90 minutes to complete instead of the usual 35-45 minutes due to the patient's morbid obesity, as described in the operative report."

Coding tip: Limit your use of modifier 22 to surgical codes with 0, 10, or 90 day global periods.

Resources: To review the NAS policy, check out "Medicare B News," Issue 274:

• Start at www.noridianmedicare.com
• Hover over Medicare Part B, and choose Jurisdiction F
• Accept the End User Agreement (if necessary)
• Hover over News and Publications, and select Bulletins.

For more on Medicare's views of Modifier 22, review Medicare Claims Processing Manual, Chapter 12, Section 40.2.A.10 (www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf).