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Lysis of Adhesions, extensive

  1. Question Lysis of Adhesions, extensive
    Medical Coding Books
    I have a general surgeon who performed an extensive lysis of adhesions, over 2 hrs. Total operative time 5 hours and he wants to know if we can bill for the extra time due to the patient's adhesions and morbid obesity. He also performed a partial colectomy. Can we add a modifier to these procedures since they took quite a bit longer, or are we not able to bill for the extra time that this involved? Any suggestions?
    Thanks!

  2. #2
    Location
    Albany, New York
    Posts
    457
    Default
    Review the description of Modifier 22 in your CPT book and if use of that modifier is supported by your physician's documentation, go with it.
    Karen Maloney, CPC
    Data Quality Specialist

  3. #3
    Location
    Columbia, MO
    Posts
    12,841
    Default
    Yes the 22 modifier is the one to use. As long as the docuemntation supports extensive nature of the procedure. If the physician states morbid obesity then it is advisable that the BMI be documented and add that V code. Also do not use the code for the adhesiolysis, code the main procedures and append the 22.

    Debra A. Mitchell, MSPH, CPC-H

  4. Default
    Quote Originally Posted by mitchellde View Post
    Yes the 22 modifier is the one to use. As long as the docuemntation supports extensive nature of the procedure. If the physician states morbid obesity then it is advisable that the BMI be documented and add that V code. Also do not use the code for the adhesiolysis, code the main procedures and append the 22.
    When using modifier 22 - should the amount for this procedure be increased above what is normally charged?

  5. #5
    Location
    Columbia, MO
    Posts
    12,841
    Default
    No I always do this in my cover letter where I explain why a 22 was appended and then request a 30% increase ove the usual amout. I have never been disappointed. You do need a great cover letter, spell it all out for them, do the review you expect them to do with your cover letter.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Location
    Milwaukee WI
    Posts
    4,466
    Default 22 modifier
    We DO increase our fee by (usually) 25% when we add the -22 modifier.

    I absolutely agree with Debra that you need a good letter of explanation as to why you are requesting the additional monies.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  7. #7
    Default
    We too increase our charge when billing the -22 modifier and submit claims with a coverletter, medical rationale and industry (NCCI)guidelines/specialty billing guidelines or payer billing guidelines to support increased payment.

    Julie, CPC
    Last edited by jdrueppel; 01-29-2010 at 06:11 AM.

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