Neurosurgery Coding Alert

The AMA works harder to convince you of documentation's importance If you-ve been less than stringent when applying modifiers 22 and 59, CPT 2008 includes revisions aimed squarely at you. A new descriptor for modifier 22, as well as new verbiage in CPT Appendix A ("Modifiers") for modifier 59, serves notice that payers are likely to tighten down even further on claims containing these modifiers. Stress -Substantially Greater- Than Usual for 22 In 2008, the descriptor for modifier 22 will specify "increased procedural services," rather than "unusual procedural services" as in years past. Along with this subtle shift in definition, Appendix A includes new instructions for the modifier: "Documentation must support the substantial additional work and the reason for the additional work (i.e., increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required)" [emphasis added]. The new language sounds a lot tougher than the old wording, but you-ll have to wait for guidance on what "substantial additional work" means, says Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC. In fact, the changes are probably an effort to ensure that physicians and coders are applying modifier 22 as has always been intended. Coding experts have long specified that you should apply modifier 22 only when documentation supported the need for considerable additional physician time, effort or resources, and that you should list the reasons for the additional effort when submitting your claim. To say that a procedure deserved modifier 22 simply because it was "unusual" has never been true. What matters (and has always mattered) is that the procedure must be unusual in the sense that it required substantially greater physician effort, time or resources to complete. "Repeated reviews by Medicare have shown that doctors are not supporting modifier 22 well enough in their documentation," says Dianne Wilkinson, RHIT, compliance officer and quality manager with MedSouth Healthcare in Dyersburg, Tenn. So the CPT update is beefing up the documentation requirements to encourage you to do what you should already be doing, she adds. Documentation MUST Support 59 Text accompanying the descriptor for modifier 59 (Distinct procedural service) in Appendix A now states unequivocally, "Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual." This differs from past versions of CPT, which specify merely, "Modifier 59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances." With round after round of modifier 59 crackdowns by the HHS Office of Inspector General, Medicare payers and others, the [...]