Wiki Modifier 52 and 22 billed together???? yes/no

[hmgts24@gmail.com]

I have a Right Total Hip Arthroplasty (failed THA) to bill with the acetabular liner only and femoral component replaced. I have researched and found that the best CPT for this is 27134 with the modifier 52; however the surgeon would like to bill a modifier 22 for additional time > 50% due to morbid obesity of patient. Can I bill the 27134 with both modifiers or if not, what is my best option for the highest reimbursement?

Thank you,

 

[thomas7331]

It doesn't really make sense to use 52 and 22 together as it's contradictory. If you're going to use 22, you'll probably need to submit records for review and that will ultimately determine the amount of payment. I think what I might suggest doing here is use 27138-22, coding for the femoral component only, and with the 22 modifier representing the extra work both for the physician time and for the acetabular liner replacement. In my experience, if you use 52, the payer is likely to take a pretty substantial automatic reduction to your overall payment and only give you a little bit back for the 22 modifier, if anything. I'd also recommend submitting a cover letter with your records pointing out to the payer exactly what supports the additional payment.