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90806 with modifier 22?

  1. #1
    Default 90806 with modifier 22?
    Medical Coding Books
    I read a CPT assistant article this AM and it indicated that if you have a 60 min 90806 appt, you can bill that code with 22 mod...

    How is that appropriate? Code 90806 is approximately 45 to 50 min.

    The next code up, 90808, is 75 to 80 min. Wouldn't the 60 min appt just be rounded to the nearest code?

    Do any of you use that and get reimbursed for it?

  2. #2
    North Carolina
    I suppose, if documented thoroughly, the modifier could be justified. Our Rehabilitation and Pain Mgmt physicians bill for these services. I can say that in the years I've overseen their coding, they haven't used this modifier. I know that many of our patient's are dealing with severe depression and suicidal tendencies...this could be one of those instances where modifier 22 could be justified for the difference in time. However, as stringent as carriers are today, I just can't see the reimbursement being that much more. If nothing else, due to the nature of the business, maybe the modifier could be for reporting purposes.

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