Neurology & Pain Management Coding Alert

Don't miss what an updated modifier 25 has in store for PAs and CRNPs CPT 2008 includes revised and expanded descriptors for seven modifiers that you can append to procedure codes, plus it adds a new modifier to your collection. Here's what you need to know, including insider tips on the two that will affect your neurology claims most: modifiers 22 and 59. Modifier 22's Usage Expands -- and Tightens The modifier 22 descriptor you-re used to read, "Unusual procedural services." CPT 2008 expands the times you-ll call on modifier 22 by updating its descriptor to "Increased procedural services." A few key differences between the old and new definitions include: - The old definition instructed you to report modifier 22 "when the service(s) provided is greater than that usually required for the listed procedure." Now modifier 22 doesn't just cover the service your physician provides -- it also includes the "work required to provide a service." - The difference between the standard service and the service your physician provides must be "substantially greater" than typically required, according to the new descriptor. - The 2008 explanation spells out your documentation requirements. You can document the extra work and the reason for it through information such as "increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required." Filing note: "It's best to send a cover letter or copy of the report and underline the portion you feel warrants modifier 22," says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, CodeRyte Inc. coding analyst and coding review teacher. "If you highlight the section, it will either be blocked out or drop off during the scanning process that most payers employ." - The new explanation ends with a reminder that you should not report modifier 22 with an E/M service. According to CPT Changes 2008 -- An Insider's View, "The language was revised to include that substantially greater services than typically provided must be performed in order to report modifier 22. Documentation must support the substantial, additional work and the reason for the additional work." Some Modifiers Open Door to Other Practitioners Several modifiers include slight changes to their explanations. One to note: CPT deletes the term "physician" from the Appendix A explanation for modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Now, instead of stating in its explanation that "the physician may need to indicate - the patient's condition required a significant, separately identifiable E/M service -," the explanation says, "It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's [...]