Otolaryngology Coding Alert

Using an unlisted procedure code as alternative could mean lost revenue. Catch-22: If you're using modifier 22 on almost all your otolaryngology surgical cases, you're headed for an audit. But if you're not using modifier 22 at all, you could be passing by avenues for ethical and additional reimbursement. In the past, some Medicare carriers have suggested that physicians should use modifier 22 (Increased procedural services) with fewer than 5 percent of all surgical cases. In other words, you should always apply modifier 22 sparingly -- but that doesn't mean you should never use this modifier at all. Key: When a surgery may require significant additional time or effort that falls outside the range of services described by a particular CPT code -- and no other CPT code better describes the work involved in the procedure " modifier 22 is your best option, says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, [...]