Deaconess Posted Wed 17th of January, 2018 12:37:51 PM
I have a question on CPT 34203. Our doc performed two of these one in the posterior tibial and the other anterior tibial. He was wanting to charge for 2, but the MUE is one so he obviously can't, and then came back with wanting to add a 22 modifier onto the cpt. Do you happen to have any written information on this code stating only one can be charged out no matter how many were done in that part of the extremity? He is a tough one and we will need something to back up our response.
Thank you in advance.
The doc requested if he can't bill two 34203 then he wants it billed with a -22 modifier since he performed two.
SuperCoder Answered Thu 18th of January, 2018 08:15:44 AM
As per MUE only one unit is billable for this CPT code 34203. 22 modifier is for Increased Procedural Services: When the work required to provide a service is substantially greater than typically required. It may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial work (i.e., increased intensity, time, technical difficulty of procedure, severity of patient’s condition, or physical or mental effort required). Please check for the documentation given by provider.
Hope this helps!