Wiki Modifier 22 - There are two occasions for general

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ljmosh

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There are two occasions for general surgical procedures when I use modifier 22 (unusual procedural services). One of these is if lysis of adhesions is performed during abdominal surgery such as open appendectomy and the operative note documents that more than two hours of time were required to perform the lysis (CPT 44950-22). The other occasion is for a laparoscopic procedure converted to an open procedure such as endoscopic cholecystectomy with cholangiography converted to open cholecystectomy (CPT 47562-22).

Are these appropriate uses of modifier 22?

Also, does anyone have experience as to whether Medicare and private insurers increase their fees to reimburse for the inclusion of modifier 22?

Thanks in advance for your reply (replies)

ljmosh
 
Medicare and the other private payers will pay additional if you send in an appeal with the op-note also increase your normal fee when the charge is posted. When coding lap converted to open procedures a 22 is not appropriate, instead code the open CPT code example: 47562 should be 47600 and use the ICD-9 code V64.41 as a secondary diagnosis. Hope this helps.
Michael D. Reyland, CPC, CIRCC
Surgical Specialists of Georgia
 
Michael,

Thanks for the reply.

I intended to include 47605 as the example of the open procedure that was performed after 47563 was attempted. I am almost certain that I read somewhere (possibly in a coding newsletter) that modifier 22 should be used in this case but I appreciate your forthrightness.

Regarding the fee situation, I must enter the procedures into a system that does not allow me to change the fee as the claims go electronically to a central billing office and then are submitted electronically to the payers. Also I no longer have a "paper" claim option so it appears in my present situation, use of the modifier 22 is of no benefit.

Thanks again for the reply,

ljmosh
 
Central billing office

There has to be some way to manually enter a fee ... how would you price unlisted codes without that ability?

Check with your central billing office. They may have software edits that recognize the -22 modifier (or -52 for that matter) and either drop those claims to a report to be worked by an individual, or automatically adjust the fee accordingly.

If there really is no such method they are leaving some serious money on the table!

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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