Unusual or increased? Your modifier 22 use now depends on the difference
The new musculoskeletal codes may hold the most exciting changes for orthopedic coders in the new year, but you-ll also benefit from changes to the modifier descriptors and the E/M codes.
The most dramatic modifier change is that the descriptor for modifier 22 will change from "unusual procedural services" to "increased procedural services."
According to CPT 2008, the physician's work must be "substantially greater than typically required" to warrant using modifier 22. And your documentation must support the "substantial additional work." You must also document the reasons why the doctor had to work harder, such as increased intensity, added time, the procedure's technical difficulty, severity of the patient's condition, or physical and mental effort required.
The new language sounds a lot tougher than the old wording, but you-ll have to wait for guidance on what "substantially greater" means, says Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, director of outreach for the American Academy of Professional Coders in Salt Lake City.
Modifier 59 changes: The description for modifier 59 (Distinct procedural service) now says that "documentation must support" that there was a separate session or distinct service. Cobuzzi says she's been teaching all along that your documentation must support modifier 59. "They-re just clarifying it because there's been so much abuse on 59."
E/M Changes Abound
CPT 2008 will debut several new E/M codes that will benefit orthopedic practices, but half of them are simply replacements for codes removed from CPT 2008. For instance, medical team conference codes 99361 and 99362 have been deleted and replaced by three all-new codes:
- 99366 -- Medical team conference with interdisciplinary team of healthcare professionals, face-to-face with patient and/or family, 30 minutes or more, participation by nonphysician qualified healthcare professional
- 99367 -- Medical team conference with interdisciplinary team of healthcare professionals, patient and/or family not present, 30 minutes or more; participation by physician
- 99368 -- - participation by nonphysician qualified healthcare professional.
Codes 99366-99368 differ from their predecessors (99361-99362) in several ways. First, 99366 and 99368 apply to nonphysician healthcare professionals (NPPs), such as a nurse, nurse practitioner, physician assistant, etc. Both code descriptors specify a minimum service time of 30 minutes or more, but 99366 also stipulates that the patient and/or family be present during the conference.
"These codes [99366 and 99368] were added to allow the inclusion of nonphysician, qualified healthcare professionals," says Susan E. Garrison,-CHC, PCS, FCS, CCS-P, CPAR, CPC,-CPC-H, executive vice president of Healthcare Consulting Services.
-Patient presence matters: Many payers, including Medicare, will not reimburse separately for non-face-to-face services -- which means insurers will likely not recognize 99368 (during which the patient [...]