Can you use both modifiers 52 & 22 together? It hit our scrubber. It fits the situation. I think I've successfully billed one that way some years ago.
How about when you append 52 for a procedure that someone else opened the case and your doc is coming in to do a different service. Which turns out to be far more difficult than the norm. Say it took 25% longer than the average 2 hours it normally takes. And it is well documented.
Playing the devil's advocate.