Radiology Coding Alert

If your services exceed the procedure code description,append modifier -22 As long as your radiologist documents increased difficulty or additional time that warrants extra compensation and you are willing to take a few extra steps in the claims process, you may be able to realize a pay increase if you judiciously apply modifier -22. Learn to Recognize 'Unusual'Procedures "Modifier -22 (Unusual procedural services) is used to indicate that a procedure was complicated, complex, difficult or took significantly more time than usually required by the provider to complete the procedure," said Deborah Berry, CPC, during her presentation, "Modifiers, The Key to Reimbursement," at the American Academy of Professional Coders' 2004 national conference in Atlanta. CMS guidelines stipulate that modifier -22 indicates "an increment of work ... infrequently encountered with a particular procedure" and not described by another code.

"The modifier -22 is for those very select cases where the amount of work goes way above the norm," says Jean Ryan-Niemackl, LPN, CPC, application specialist at QuadraMed in the Government Programs Division, Fargo, N.D.

But don't use modifier -22 indiscriminately, Ryan-Niemackl says. "It is important to understand when practicing medicine that a percentage of the cases will be easier than normal and a percentage of the cases will be harder. Just because a procedure is harder doesn't mean that you should add modifier -22."

Increased procedure time due to lack of physician skill or to deal with a complication that is a known and expected outcome does not warrant appending modifier -22. To justify using modifier -22, there should be something truly unique about the patient, such as a scarred surgical site or abnormal anatomy, that causes additional work above and beyond what the physician expects, even considering potential complications. For example, Ryan-Niemackl says, a positron emission tomography (PET) scan with extra sequences might warrant modifier -22 appended to the appropriate PET scan code (such as 78810, Tumor imaging, positron emission tomography [PET], metabolic evaluation). Some coding experts estimate that you should only apply modifier -22 to less than 3 percent of all claims. "You take all the procedures that your practice performs and put them on a scale," Ryan-Niemackl says. "At the middle point is your average procedure; those to the left are easier than average, and those to the right are harder. Next, you calculate the middle 95 percent off the curve and what you have left is 2.5 percent of the easiest procedures and 2.5 percent of the most difficult. The 2.5 percent of the most difficult would represent the number of times a clinician would apply modifier -22." Modifier -22 Rarely Increases Payment When you use modifier -22, you should charge your usual amount, plus an additional 20 [...]