F Posted 8 Year(s) ago
Can someone tell me what will constitute increased procedural services
(modifier 22)for total hip arthroplasty. My doctor has doccumentation of Morbid Obesity, body mass index 54. Does this suffice for using modifier 22.
SuperCoder Posted 8 Year(s) ago
Documenting Morbid Obesity, body mass index 54 is not sufficient enough for 22 modifier.
You will want to consider appending modifier 22 (Increased procedural service) when the service(s) the physician provides is substantially greater than typically required, according to CPTs Appendix A (Modifiers). To support using this modifier, your physicians documentation must support the substantial additional work and must list the reasons why the doctor had to work harder, such as increased intensity or added time.
With appropriate documentation and judicious application, modifier 22 can yield increased payment for especially difficult or time-consuming procedures. But you must use this modifier with caution because overuse may be a red flag to carriers monitoring claims coded for the purpose of obtaining improper payment.
To know about this modifier check
Patricia Posted 7 Year(s) ago
I disagree straight out of the web site given above see below the 3rd line
Situations that might call for modifier 22 include (but are not limited to):
Excessive blood loss for the particular procedure
Presence of excessively large surgical specimen (especially in abdominal surgery)
Trauma extensive enough to complicate the particular procedure and not billed as additional procedure codes
Other pathologies, tumors, malformation (genetic, traumatic, surgical) that directly interfere with the procedure but are not billed separately
Services rendered that are significantly more complex than described by the CPT code in question.
8 Year(s). There are 4 posts.
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is from Patricia