Cardiology Coding Alert

 96 percent of the time, CMS call centers won't be of any help When appending modifiers -22 and -57 to cardiology procedures or visits, you shouldn't rely on "what someone told me" - even responses from CMS call centers.
 
A study by the Government Accountability Office (GAO) reports that 96 percent of the answers provided by CMS call centers - including answers to cardiology coders' questions - are inaccurate, only partially correct, or totally incomplete.
 
See how the GAO's "correct and complete" answers to two of four cardiology-specific questions stack up to the advice of our cardiology coding experts. (See next month's edition of Cardiology Coding Alert for the other two questions.) Combat Denials With Documentation for Modifier -22 Question: Do carriers pay for second surgical procedures performed by the same physician on the same day but during different operative sessions?
 
What the GAO counted as the correct and complete response: "If the physician believes that extenuating circumstances exist for performing multiple surgeries on the same day and that these surgeries would be paid at the full amount, he or she may bill for the surgeries with modifier -22. After reviewing the operative report, the carrier may determine that the standard adjustment rules do not apply and pay 'by report.' " What's left out: In order for carriers to see the report, you will have to file your claim in hard-copy format and attach the operative report and a cover letter explaining why you used modifier -22 (Unusual procedural services).
 
Without documentation, carriers will deny claims with the reasoning that they require additional information before they can adjudicate the claim, says Jim Collins, ACS-CA, CHCC, CPC, president of Compliant MD Inc. in Matthews, N.C.
 
The operative report should clearly identify additional diagnoses, pre-existing conditions or any unexpected findings or complicating factors that contributed to the extra time and effort spent performing the procedure.
 
Every operative note should have a separate section - such as a "Special Circumstances" section - in which the physician must indicate when a procedure is significantly more difficult than anticipated.
  
Keep in mind: There's a good chance that the person employed by the insurance carrier to review your claim is not a medical professional. So you have to translate what went on in the operating room into quantifiable terms.
 
CPT guidelines indicate that "when the service(s) provided is greater than that usually required for the listed procedure, it may be identified by adding modifier -22 to the usual procedure code." And convincing the carrier that a procedure was "greater than that usually required" is crucial for claims with modifier -22, because when approved, these claims will yield additional reimbursement - in many cases an additional 20 to 25 percent more [...]