New Modifier Recognizes Additional Work for Revisions
Published on Fri Dec 01, 2000
CPT 2001s new modifier -60 (altered surgical field) could be good news for otolaryngologists and their coders. Until now, any procedure that was complex and required additional work and time was coded and billed with modifier -22 (unusual procedural services).
As of Jan. 1, 2001, however, if the procedure is more complex because the otolaryngologist has encountered an altered surgical field, CPT instructs surgeons to use modifier -60.
CPT describes modifier -60 as follows:
Altered Surgical Field: Certain procedures 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, irradiation, infection, very low weight (i.e., neonates and small infants less than 10 kg) and/or trauma (as documented in the patients medical record). These circumstances should be reported by adding the modifier -60 to the procedure number or by use of the separate five-digit modifier code 09960.
Many coding specialists like this new modifier because it more clearly explains why the work was more complicated and/or took more time. It also implies additional payment without excessive documentation for situations, such as revisions of prior surgery, where it is clearly called for. But until Medicare and other carriers announce documentation and reimbursement criteria for using the modifier, its value remains questionable.
Meanwhile, otolaryngologists and their coders will need to distinguish between complicated procedures requiring modifier -60 and those that still should be billed using modifier -22.
The description of modifier -60 includes this note:
For unusual procedural services not involving an altered surgical field due to the late effects of previous surgery, irradiation, infection, very low weight (i.e., neonates and infants less than 10 kg) and/or trauma, append the modifier -22 or use the separate five-digit code 09922.
Modifier -22s description also has been amended:
When the service(s) provided is greater than that usually required for the listed procedure, it may be identified by adding modifier -22 to the usual procedure number or by the use of the separate five-digit modifier code 09922. A report may also be appropriate. Note: This modifier is not to be used to report procedure[s] complicated by adhesion formation, scarring, and/or alteration of normal landmarks due to late effects of prior surgery, irradiation, infection, very low weight ... or trauma [see modifier -60 as appropriate].
What Is an Altered Surgical Field?
As of Jan. 1, when the otolaryngologist performs a procedure that requires more work and/or more time, the correct modifier must be chosen if additional payment is sought. To do so, coders need to understand what an altered surgical field is.
The surgical field is the site where the operation is performed. Usually, surgeons encounter a [...]
