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Can I bill a 45332 with modifier 22 AND modifier 53?

Tammy Posted Tue 26th of June, 2012 20:27:12 PM

Patient had foriegn body in rectum. Dr attempted a '45332' but after 75 minutes was unable to retrieve object. Pt referred for surgical intervention. What would be the proper way to code this?

SuperCoder Answered Tue 26th of June, 2012 21:35:20 PM

45332-53. It was an attempted procedure. The motive was not accomplished .

Using modifier 22
Generally modifier 22 is used sparingly--but that doesn’t mean you should never use this modifier at all. When a procedure may require significant additional time or effort that falls outside the range of services described by a particular CPT code--and no other CPT code better describes the work involved in the procedure--modifier 22 is your best option. Here are a few tips for using modifier 22.
Know When to Use Modifier 22
You should use modifier 22 “when the service(s) provided is greater than that usually required for the listed procedure,” according to CPT. However, neither CPT nor Medicare provides guidelines about what type of service merits its use--that’s up to you.

Support the ‘Increased’ Argument
CPT designed modifiers to represent the extra physician work involved in performing a procedure because of extenuating circumstances present in a patient encounter. Modifier 22 represents those extenuating circumstances that don’t merit using an additional or alternative CPT code, but instead raise the reimbursement for a given procedure. The key to collecting reimbursement for increased procedures is all in the documentation. Sometimes a physician will tell you he did “x, y and z,” but when you look in the documentation, the support isn’t there. Documentation is your chance to demonstrate the special circumstance that warrants modifier 22.
Also, don’t forget to add on the additional dollar amount that you are asking for by using the modifier. Payers just don’t pay you extra with this modifier; you need to say I am asking for ____ extra and this is why.
Count Time as a Vital Factor
Some experts suggest that you shouldn’t use modifier 22 unless the procedure takes at least twice as long as usual. Several memorandums from Medicare carriers indicate that time is an important factor when deciding to use this modifier.

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