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MOd 22

  1. #11
    Duluth, Minnesota
    Medical Coding Books
    ok, just checked the info from the conference I had gone to that explained the modifier 22 more specifically- they referenced the link I posted (and mbort posted the report). They pointed it out and made it clear that"Please note, surgery for an obese person, surgery encountering adhesions or surgery that takes longer than usual to complete, does not in and of itself warrant extra payment. [COLOR="Blue"]**however*These conditions could warrant additional payment if they cause a marked increase in the time and effort of performing the operation.[/COLOR] <---((and this is where they clarified explaining that if it takes 2 hours to do something on a specific type of person (eg; obese) as opposed to the same surgery taking 1 hour on a average size person - then 2 hours is "TYPICAL" for that surgery on an obese person and therefore should not append the modifier 22. IF it takes more than the "typical" time already established for surgery on that type of person (obese) THEN, the 22 modifier should be added and documentation supporting the services should be sent with the charges.))Therefore, NAS requires the provider to clearly indicate why this case is beyond the usual range of difficulty for procedures reported with the code.

    again, this is what I got out of the article itself and the presentation when the speakers explained it further in the conference room. The speakers ranged from Medicare Fraud Investigator, Wisconsin Medical Group Management Association Medicare, WPS Part B, POEAG, MMA, AHIMA, MHIMA, MMGMA to name a few. Oh, and an attorney for Health Care Fraud & Compliance. It was an awesome seminar.!!

    Their explanation made perfect sense to me - often the speakers didn't always agree on some topics being talked about (I guess that happens everywhere, even here in forum) But on this, they all shook their heads up and down, all felt the same way - it all depends on what is "typical". Since their explanation clarified the use of modifier 22 - (at least to me and fellow coders who discussed it later), it's how I base my usage of it on now. I feel confident when I make that decision to use it or not.

    (forgot to mention, they referenced the article and they had their own examples in the book : the examples came from Wisconsin Medical Society)
    Last edited by dmaec; 07-31-2008 at 08:09 AM.
    Donna, CPC, CPC-H

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