Neurosurgery Coding Alert

When it comes to modifier -22, you have to ask to receive Appending modifier -22 won't automatically increase your surgeon's compensation for an unusually difficult or time-consuming procedure, but if you provide solid documentation and specifically request an adjusted fee, you'll stand a better chance of recouping pay.

Here are four expert-approved tips to guide your modifier -22 (Unusual procedural services) claims. Step 1: Make Clear the Additional Effort Before you even consider appending modifier -22, you must be sure that your documentation will support the claim.

In particular, you must show that the surgery you are claiming falls outside the expected "range of service" as described by the CPT code(s) you submit.

In other words, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of Cash Flow Solutions Inc., in Brick, N.J., some surgeries will be easier than others and some more difficult, but only if the surgery is truly unusual - and you can prove it - will the payer honor a modifier -22 claim.
 
At minimum, the surgeon should outline, in detail, the unusual complexity of the surgery - as well as the reason for the complexity - in the operative note. And you should submit the full operative note with your claim. Step 2: Include a Cover Letter Provide a cover letter with your modifier -22 claims explaining, in plain English, why the surgery was unusual. Directly compare your "unusual" surgery to a "typical" surgery of the same type to show the payer why you are justified in asking for additional compensation.

Payers carefully scrutinize modifier -22 claims before making any additional payment. By providing a clear, concise summary of the clinical challenges that made the surgery unusually difficult, you make it that much easier for the payer to decide in your favor.

Example: During diskectomy (63075, Diskectomy, anterior, with decompression of spinal cord and/or nerve root[s], including osteophytectomy; cervical, single interspace), the surgeon encounters extensive scarring and adhesions resulting from previous surgery. The scarring significantly increases the surgeon's effort to access the disk and free the nerves, and adds 50 minutes to the "usual" time the surgeon requires to complete a diskectomy.

In this case, submit a claim for 63075-22. Provide the surgeon's operative note outlining in full the nature and extent of the procedure.

Also include a cover letter that explains, for instance, "Due to extensive scarring and adhesion, the surgeon required an unusual effort to access the disk and surrounding nerves. This required about one hour of additional time and effort over and above that usually required for a diskectomy of this type." Step 3: Request Additional Payment When submitting a modifier -22 claim, don't think that the payer will just offer additional compensation: You should specifically [...]