Orthopedic Coding Alert

In Program Memorandum B-00-75, dated Dec. 21, 2000, HCFA announced that it will not recognize modifier -60 (altered surgical field). The agency is afraid that modifier -60 will be used routinely where additional work has already been included in the code. Therefore, until further notice, physicians should use modifier -22 instead for unusual procedural circumstances. The text of the memorandum is below:

In 2001, CPT added the -60 modifier for altered surgical field. We believe modifier -60 was added because surgeons wanted to clarify the factors that should be considered to justify the use of the modifier -22 (unusual procedural services), and to remove the discretion of the payers about whether a procedure was indeed unusual. The instruction for the -60 modifier is that it be used on procedures which involve significantly increased operative complexity and/or time in a significantly altered surgical field resulting from the effects of prior surgery, marked scarring, adhesions, inflammation or distorted anatomy. An example cited in the modifier explanation is that surgery in any infant less than 10 kg (22 pounds) would qualify for the use of the -60 modifier.

HCFA believes that recognition of the -60 modifier will result in its routine use with a variety of procedures that are typically performed in infants (and already valued as being performed in an individual less than 10 kg). The instructions for the use of the -60 modifier would also add it to procedures such as 27134-8, revisions of total hip arthroplasty. Again the value of the additional work is reflected in these codes. We also believe that verification of the status of an altered surgical field will be difficult for our contractors. Manual review of these claims, which are likely to be more frequent than claims carrying the current -22 modifier, is likely to consume considerable contractor medical review effort with objective verification of the altered surgical field difficult or impossible. We believe that the -22 modifier, which requires documentation that the procedure was unusual, is sufficient to allow carriers to adjust the compensation of physicians when the service is beyond the expected variation in work of a procedure. For these reasons, we request that physicians continue to utilize the -22 modifier to indicate that the circumstances encountered in the procedure were unusual.