Physicians wanted modifier -60 to get an extra percentage into the fee for complicated surgeries, Repka says. HCFA didnt want this modifier, he notes. In many instances, modifier -60 will replace modifier -22 (unusual procedural services). Because HCFA thought modifier -22 was overused, they agreed to create modifier -60.
Ophthalmologists should use modifier -60 for procedures that involve more complexity and/or time in an altered surgical field. The alteration must result from:
very low birth weight (i.e., neonates and small infants less than 10 kg); or
Use modifier -22 for operative complexity caused by circumstances other than those previously listed.
Modifier -60 can be appended to codes if the requirements (listed above) for the modifier are fulfilled. But many codes are in a gray area sometimes they can be used with modifier -60, and sometimes they cannot.
Exactly how modifier -60 will play out in terms of local Medicare carriers and other payers is unclear at this point. We dont know that the carriers will have a limited list of surgical codes, notes Raequell Duran, president of Practice Solutions, a Santa Barbara, Calif.-based ophthalmology coding and compliance consulting firm. But Duran agrees that proper coding requires that attention be paid to the descriptors of the procedure before using modifier -60. Keep in mind that there are codes already existing in CPT that have an inherent value for the extra work involved, Duran advises.
At this time, there is not a set percentage of increased payment that is going to be attached to the use of modifier -60, Duran says. As with modifier -22, which -60 will replace in many instances, carriers will have to review the operative report for the service in order to determine payment. It takes extra time to submit a paper claim and pull the op note. Make sure the [...]