Wiki 22 modifier with obesity

[nmmjbm]

When a provider uses the 22 modifier for increased time and effort due to obesity, is it required to document the BMI? If so, where should this be documented. This is What was documented in the op report: Findings: I am adding a 22 modifier to this case due to the added increased work required due to her morbid obesity. There was 50 to 75% greater effort causing technical difficulty increase time and mental effort in order to place this femoral implant. This case took at least 2 hours longer than it should take.

 

[csperoni]

For -22, the note must indicate the additional work or time or effort that was required. In this case, I would consider that documentation sufficient for -22. The physician does specify "morbid obesity", which I would add as a secondary diagnosis. The notes on E66.01 state "Use additional code to identify body mass index (BMI), if known (Z68.-)". Since in your case, the BMI is not known, you would not be able to use the additional Z68.-.
I would educate my clinicians that a best practice is to include the BMI, but I would not consider it required to use -22.

 

[xXxPARAGONxXx]

When a provider uses the 22 modifier for increased time and effort due to obesity, is it required to document the BMI? If so, where should this be documented. This is What was documented in the op report: Findings: I am adding a 22 modifier to this case due to the added increased work required due to her morbid obesity. There was 50 to 75% greater effort causing technical difficulty increase time and mental effort in order to place this femoral implant. This case took at least 2 hours longer than it should take.

The provider has stated the patient is morbidly obese. You can abstract that information for coding purposes, i.e., E66.01. Then, assuming the patient's height and weight have been documented at some point during the pre-op evaluation period by surgeon's or anesthesiologist's staff, calculate the BMI from that height and weight. Once calculated, obtain the corresponding Z68 code. Add both of those codes (E66.01 and Z68.##) to the claim for the surgery with modifier -22 added to the CPT code.

BMI = weight (lb) / [height (in)]^2 x 703