Part B Insider (Multispecialty) Coding Alert

Published on Fri Apr 30, 2004 PDF

If the physician did extra work, consider modifier before unlisted code

Doctors go above and beyond the call of duty every day. They work tirelessly to help patients, putting in so much effort that it scarcely seems like a single CPT code can capture the work in a particular procedure.
 
Usually, you find the right code to describe their work. But sometimes, their efforts go so far beyond the usual services described by a code that they appear to have performed an extra procedure along with the listed procedures. And this extra procedure doesn't seem to have a code of its own.

When this happens, you have two choices: use a Not Otherwise Classified (NOC) code or the -22 modifier (Unusual procedural services). Part B Carrier WPS Medicare Administrators says in its latest bulletin that it's received a number of claims with a NOC code "tacked" onto a number of other CPT Codes. The operative note makes it difficult to understand which part of the procedure the NOC code is describing.

So when you already have a group of procedure codes, WPS encourages providers to use the -22 modifier instead of the NOC code.

But some coding experts say that the -22 modifier doesn't provide enough clarity for unusual services. "If the majority of what you're doing is described by existing codes except that there are adhesions or something requiring a little more time, the -22 fits perfectly, says Jean Stoner, manager of coding operations for CodeRyte in Bethesda, MD. But "if this extra work is turning it into an entirely different procedure, using the -22 would not be appropriate."

Laura Talbert with Shore Billing & Management in Allen, MD works with an ENT physician who must perform two or three other procedures before he can perform a tracheostomy on some of his obese or elderly patients. "Just putting a -22 modifier on a code isn't going to justify the amount of work they're going to get." The added reimbursement with the -22 modifier is likely to be 50 percent or less, she adds.