Wiki Modifier 22

[ddee216]

Can someone clarify this information from the reading for me? If you code an open procedure after failed endoscopy with mod 22, it's possible to ALSO code the endoscopy? And does the endoscopy receive modifier 22 as well? TYIA!

"Modifier 22 can be appended when an endoscopic procedure is converted to an open procedure. In this case, only report the open procedure and append modifier 22. To be reimbursed for attempting the endoscopic procedure, modifier 22 can be appended—if the service is significant"

 

[OpenClaims]

Can someone clarify this information from the reading for me? If you code an open procedure after failed endoscopy with mod 22, it's possible to ALSO code the endoscopy? And does the endoscopy receive modifier 22 as well? TYIA!

"Modifier 22 can be appended when an endoscopic procedure is converted to an open procedure. In this case, only report the open procedure and append modifier 22. To be reimbursed for attempting the endoscopic procedure, modifier 22 can be appended—if the service is significant"

I have never heard of using the 22 modifier like this before. The 22 modifier is used for "increased procedural services" which means you are doing more then what is expected for that particular procedure. Our guidelines tell us when a procedure is converted to open you would code for only the open procedure. Now if the provider did way more work on the open procedure then you would add the 22 modifier to demonstrate that more work was performed. Like, "the provider spent 2 extra hours lysis of adhesions" you would add the 22 modifier to that procedure and write your reason for adding the 22 modifier in box 19 on the claim form.
NCCI edits state "4. If a laparoscopic procedure is converted to an open procedure, only the open procedure may be reported. Neither a surgical laparoscopy nor a diagnostic laparoscopy code shall be reported with the open procedure code when a laparoscopic procedure is converted to an open procedure" This is in your chapter 6 of your written NCCI edits on the cms.gov website.