Wiki Modifier 22 HELP!!!!

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mieka.schambach

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So my dr is billing a 47562 with a modifier 22, he did a lap chole with lysis of adhesions which took over 50% of the case. How do we get paid for this additional procedure (the lysis) that was done considering he only billed a lap chole? this is Medicare so I can't just send medical records with a paper claim.
 
Modifier 22 is the proper way to submit this, you will need to send a copy of the operative note. Also append the dx code for the adhesions and link it also to the procedure.
 
Medicare also wants a mod 22 form from dr listing reason for appending 22 mod such as the extra time, more complex decsion making, anatomy of patient, risk to patient...........if you give me your email, i can send you a copy of the form
 
May you e mail me the information needed to submit what is needed for modifer 22 on medicare from providers I have been looking all over but have not found exact wording. Would be helpful. Skywaters80@gmail.com

Thank you
 
We have found that are Medicare carrier will not reimburse anything extra for lysis unless it's over 70 minutes extra time. Just something to track to see what your carrier's pattern is.
 
Payers may also look at the anesthesia record for the procedure - the extra time documented in the OP report should be supported in the anesthesia record as well.
 
There's a New Way To Do This

Without realizing it, CMS released the key to getting paid in a proper fashion with the modifier -22.
The problem with getting paid properly with the -22 modifier has always revolved around how to quantify it. I saw guidance in the industry stating "If it's more than 20% above and beyond what is normally expected, than add a -22, have an op note show what took extra time and send it in", at which point you prayed that you were paid beyong the upper limit of the fee schedule.
There is now a way to quantify this by time, but it has happened by accident.
To briefly summarize, as part of the work RVU value of every procedure, there is a time component. That time is calculated using the Harvard/RUC Time Study, a rolling 5-year survey of physicians used to determine average total times for all medical services. Up until 2013, CMS never made that time study available, so it was impossible to know how much time was estimated for each procedure.
Last year, out of the blue, they made it available. Go to this link. At the bottom of the page is a file entitled "CY 2014 PFS Proposed Rule Physician Time". This file shows you the median intra-service times for every CPT-coded service and procedure (on the spreadsheet under Column E).
Here's how the -22 modifier should be calculated from this sheet. We'll use the example of CPT code 47562. The median intraoperative time for this procedure, as reported by CMS, is 80 minutes. Now, you have an obese patient who requires extensive lysis of adhesions prior to gallbladder removal. With this information, you need two things in your documentation; a description of the extensive adhesiolysis and (MOST importantly) the amount of time above and beyond the surgeon's normal time spent on lysis during the procedure. So, let's say the physician states in the op note "I spent 30 minutes of additional time above what is normally expected for this procedure performing this extensive adhesiolysis". With a median intraoperative time of 80 minutes, and 30 minutes being 37.5% of 80 minutes, you now know that you can increase your fee by 37.5 % and expect to receive additional payment totalling 137.5% of the fee schedule using the -22 modifier.
It's CMS' math, it's quantifiable and it is all information that you can use on appeal if the initial payment from the carrier is less than what you have calculated.

J. Paul Spencer, CPC, CPC-H
 
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