Cardiology Coding Alert

Question: One of our physicians wants to add modifier -22 to a left heart catheterization intervention procedure. His comment was "special difficulty," but when I reviewed the report, there was no mention of "difficulty" during the procedure. He did, however, mention a previous aortic root repair with re-implantation of one of the coronary arteries and a Dacron graft. The physician spent an excess amount of time (over an hour) prior to the procedure planning the approach, due to the re-implant anatomy and graft. Is there any way to capture this "pre" procedure time/work?

Missouri Subscriber Answer: When you apply modifier -22 (Unusual procedural services), you take on an additional administrative burden. You would need to send in the claim on paper, forward a copy of the medical record, and draft a cover letter explaining why this service was unusual and justifies additional reimbursement. Frequently, this process will postpone reimbursement for a few months and does not guarantee additional reimbursement. 

If you feel that the cath report does not reflect an unusually difficult procedure compared to this doctor's typical heart caths, chances are the payer/carrier will not either. Reserve modifier -22 for those few cases when the report clearly reflects a difficult procedure.