General Surgery Coding Alert
Modifier -22 or Unlisted-Procedure Code?
New Jersey Subscriber
Answer: You can adopt this new rule of thumb: Don't use an unlisted-procedure code instead of modifier -22 (Unusual procedural services) to report additional time and effort spent performing a procedure.
Claims for unlisted-procedure codes and claims using modifier -22 both require the same amount of documentation and they take equally as much effort to submit. What's the difference? Even though both have the effect of requiring manual pricing and processing, if your claim for modifier -22 gets denied, you will be paid the fee for the procedure code alone, which can then be appealed. But if the carrier denies your claim for an unlisted-procedure code, the physician may not receive any reimbursement until the appeal is completed. You are also just as likely to be underpaid as overpaid with an unlisted-procedure code. And - processing issues aside - using the correct code with modifier -22 conforms to basic coding accuracy guidelines.
General Surgery Coding Alert
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Hint: Check for complications, open procedures Although reporting cholecystectomy is usually straightforward, you might be [...] - An ED Visit and Admission on the Same Day? Here's How
How can you code for optimal reimbursement if the surgeon sees a patient in the [...] - You Be the Coder:
Modifier -22 or Unlisted-Procedure Code?
Question: Our surgeon asks us to report procedures that take extra time and effort with [...] - Fee Schedule Update:
Higher Payments Will Boost Your Bottom Line
Once again for 2004, Congress has passed legislation that reverses a threatened reduction in Medicare [...] - If You Haven't Gone Electronic, Now's the Time
CMS final rule mandates e-claims Are you submitting Medicare claims electronically? If not, in many [...] - Reader Question:
Bill On-Call Visits as 'Established'
Question: Our physician is "on-call" for another surgeon. If he sees one of the surgeon's [...] - Reader Question:
Same-Day Observation/Discharge = 99234-99236
Question: A patient presented to the ED complaining of dizziness and nausea following a minor [...] - Reader Question:
Use Split-Thickness Codes for Keratinocytes
Question: How should I code for harvesting of keratinocytes for skin grafts?
Texas Subscriber
Answer: The appropriate [...] - Reader Question:
G-Tube Is a 'Separate' Procedure
Question: The surgeon performed both large (44140) and small (44120) bowel resection and placed a [...] - Reader Question:
Medicare Won't Recognize 'After Hours'
Question: A Medicare patient knocked on the door on a Friday when the office was [...] - Reader Question:
Select 99220 and 99217 for Multiday Observation
Question: Our surgeon treated a patient in the emergency department, and he admitted the patient [...] - Reader Question:
Report Initial Hospital Care for Admits Only
Question: I was recently called into the hospital to take over the care of a [...] - Reader Question:
Three Steps for Excision/Biopsy Coding
Question: Our surgeon obtained a partial incisional biopsy followed by excision of the same lesion. [...] - Correction
The January issue of General Surgery Coding Alert ("Have Skin Grafts Got You Guessing?" p. [...]
