jovibon110@gmail.com
Networker
Hip revision of the head and liner only - 27134-52 but the doctor wants to bill 22 mod for obesity and took 1.5 hrs longer - how would you bill this?
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Wiki Mod 52 and 22 hip revision
- Thread starter jovibon110@gmail.com
- Start date
thomas7331
Guest
Yes, it wouldn't make sense to use the modifier for a reduced work and for the additional work both. Why not use 27138-22 instead and use both the replacement of the liner as well as the extra time due to the obesity to support the additional reimbursement for the modifier 22?
jovibon110@gmail.com
Networker
With 27138 you would be getting paid for the stem removal which was not done and getting paid for the extra work mod 22. To me that is getting overpaid. They should just let you use both modifiers with a note and they can figure it out from there. Thanks for your input! 
thomas7331
Guest
With 27138 you would be getting paid for the stem removal which was not done and getting paid for the extra work mod 22. To me that is getting overpaid. They should just let you use both modifiers with a note and they can figure it out from there. Thanks for your input!
Well, the reason I recommend the modifier 22 is that (theoretically at least) it will trigger a manual review with the payer and they will review the entire operative report and price is accordingly, and it would be the payer's responsibility to consider all of the elements of the report. Modifier 52, under many payer policies, often just gives an automatic 50% reduction in payment without review. I guess as an alternative, I would use an unlisted code rather than the two contradictory modifiers together. Either way, I think you are probably in for a fight with your payer since their claims processing departments are notoriously unable to understand things of this level of complexity.
jovibon110@gmail.com
Networker
Not sure what insurance - posted for a coworker - but with dealing with MCR in the past they ignore the 22 mod and then you have to ask them to request the notes and then they review it for add’t pmt. But at least it would be reviewed vs. Automatic reduction. Appreciate your response. Makes the muddy waters a little clearer. 