Wiki Removal Femur Rod, Difficult Case

[cwilson3333]

Not sure how to code this case that took 3 hours
Removal distal interlocking screws, proximal locking screw, and intermedullar rod, right femur
CPT 20680 would be the correct code, but don't know if just adding modifier 22 to this code is sufficient.

The difficulty was removing the rod ......"Incision [third] was taken down through subcutaneous tissues with Bovie and hemostat used to dissect down through greater trochanter. Patiend found to have bone circumferentially overlying the rod. This was addressed by creating a drill down the rod, trying to clear the bone. A second larger drill was then used followed by a reamer. The locking device was not able to be fixed to the femoral rod. A guidewire was placed around the shaft of the rod. This had a hook on the end of it. Attempt was made to remove the rod in this fashion. This was unsuccessful. After doing this, the interlocking guide was able to be secured to the femoral rod and the femoral rod was then removed. "

Per the doctor, this case took 3 hours.

Operative note clearly dictates the difficulty removing the rod itself. Screws had been removed without difficulty after removing heretopic ossification overlying screw holes.

Will 20680-22 be the correct coding of this 3-hour case? I know the fee will have to be adjusted.

Would appreciate feed-back

 

[lexvcarter]

Append modifier 22 to a surgical procedure when the physician’s work required to perform the procedure is more than is typically needed.

• Modifier Explanation

In order to append modifier 22 to a surgical procedure, check that the physician documented the reason(s) why the work he performed was more than he typically performs, and the documentation should include any or all of the following:

–Increased intensity

–Additional time

–Technical difficulty

–Severe patient condition, which causes the surgery to be difficult, dangerous to the patient, and requires additional physical and mental effort from the physician

An unusual procedure is not when the physician took only a few extra minutes on the patient’s case or when the physician documents that the procedure was only slightly more difficult. There is an average range of difficulty for every procedure. A procedure could be slightly more difficult and still meet the definition of the procedure and not warrant appending modifier 22.
Recognize that truly unusual circumstances will occur in only a minority of cases. CMS guidelines stipulate that you should apply modifier 22 to indicate an increment of work infrequently encountered with a particular procedure and not described by another code. Situations that might call for modifier 22 include (but are not limited to): – excessive blood loss – presence of excessively large surgical specimen (especially in abdominal surgery) – trauma extensive enough to complicate the particular procedure and not billed as additional procedure codes – other pathologies, tumors, malformation (genetic, traumatic, surgical) that directly interfere with the procedure but are not billed separately – services rendered that are significantly more complex than described by the CPT® code in question.
Additional circumstances that could merit using modifier 22 include morbid obesity, low birth rate, conversion of a procedure from laparoscopic to open, and significant scarring or adhesions.

Modifier 22 only applies to procedure codes in the surgery section. It does not apply to E/M, anesthesia, radiology, pathology, or medicine codes

Append modifier 22 to major procedures with a 90 day postoperative period or minor procedures with a 10 day or 0 day postoperative period.

Do not assign modifier 22 if you could assign an additional procedure code to represent the increased services.

When submitting claims to the payer, increase the charge for the unusual procedure, and include a copy of the operative report to validate why the procedure was unusual. The documentation should also include the average time and effort the physician typically spends on the procedure to justify higher reimbursement for the unusual procedure.