Wiki Hysteroscopy D&C with polypectomy

[TanBro]

I thought I read somewhere that if you have a large polyp, you can add modifier 22 to CPT code 58558. Can someone confirm this for me? Also, if there is 1 large polyp and 2 small ones may I add modifier 22?

 

[csperoni]

There is no exact rule about -22, and is a judgment call based on documentation. If it was a large polyp that was easily removed, -22 is not warranted. I advise my providers that if they expect additional payment for a more complex case, the documentation must be clear about the complexity and additional work.

22

Increased procedural services. When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (i.e., increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). Note: This modifier should not be appended to an E/M service.

Here are a few references about -22
https://www.wpsgha.com/wps/portal/mac/site/claims/guides-and-resources/modifier-22
https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00135206
https://med.noridianmedicare.com/web/jeb/topics/modifiers/22
https://www.palmettogba.com/palmetto/jmb.nsf/DIDC/8EEL8Y3466~Claims~Modifier Lookup
https://www.aapc.com/blog/63312-when-to-append-modifier-22/

 

[TanBro]

There is no exact rule about -22, and is a judgment call based on documentation. If it was a large polyp that was easily removed, -22 is not warranted. I advise my providers that if they expect additional payment for a more complex case, the documentation must be clear about the complexity and additional work.

22

Increased procedural services. When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (i.e., increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). Note: This modifier should not be appended to an E/M service.

Here are a few references about -22
https://www.wpsgha.com/wps/portal/mac/site/claims/guides-and-resources/modifier-22
https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00135206
https://med.noridianmedicare.com/web/jeb/topics/modifiers/22
https://www.palmettogba.com/palmetto/jmb.nsf/DIDC/8EEL8Y3466~Claims~Modifier Lookup
https://www.aapc.com/blog/63312-when-to-append-modifier-22/

Thank you so much!! I always wondered about this. Wonderful information!!