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Radiology Coding Alert

Test Yourself:
Opt for -22 Over an Unlisted-Procedure Code

Question: Our physician asks us to report procedures that take extra time and effort with an unlisted-procedure code so he can better explain what he did and why it didn't exactly fall under a CPT Code. He also says that the payer will have to read the operative report so there is a better chance for reimbursement. I think we should be submitting the procedure code with modifier -22. Who is right?

New Jersey Subscriber

Answer: You can adopt this new rule of thumb: Don't use an unlisted-procedure code instead of modifier -22 (Unusual procedural services) to report additional time and effort spent performing a procedure.
 
Claims for unlisted-procedure codes and claims using modifier -22 both require the same amount of documentation and they take equally as much effort to submit. What's the difference? If your claim for modifier -22 gets denied, you will be paid the fee for the procedure code alone. But if the carrier denies your unlisted-procedure code claim,  the physician may not receive any reimbursement.


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