Use of 22 and 76 modifiers.


Omaha, NE
Best answers
As a new coder, CPC-A, to the orthopedic world, I am confused at how my office uses the modifiers of 22 and 76. I am told to enter a repeat surgery with a 22 modifier, and as I explained to the noncertified office manager, there has to be special circumstances with this modifier. It is just not unusual that a repeat surgical procedure is being done-is it being done for some reason.

Perhaps this is the way the insurance industry wants it; I do not know. But being taught one way and having to forget what I have been taught is extremely frustrating.

Any suggestions?
Modifier -22 is used in circumstances where the service provided was greatly above what is typical for that procedure regardless of the carrier. For repeat procedures I would look at 58, 76, 77 or 78. With the information you gave I would not deem -22 as appropriate.
If it is the case that the insurance carrier wants you to bill a certain way that is not correct coding, you need to have that in writing. Once you have it in writing you can do it but it needs to stay on file in your office in the event of an audit. It should probably be kept with the contract for that insurance so everything is together. You are correct by coding guidelines that you would not put a -22 on a surgery just because you are repeating the procedure. Show your manager appendix A in your CPT manual and it will give a description of how you should use the specific modifiers. You can also find more info from Medicare's website. If you follow Medicare's criteria you will most likely be covered (at least from a coding standpoint since they are the most strict) that you were trying to do everything possible to stay within coding guidelines and bill appropriately. Hope that helps.