Maarit Posted Tue 01st of May, 2012 16:44:54 PM
Would you code the below EGD scenario 43235 - mod. 22?
The polyp head is firm and ulcerated and oozes on several sites. Numerous attempts and accessories were used to retrieve the polyp into stomach. A rat tooth forceps, several snares, biliary stone retrieval balloon inflated to 20 mm and standard esophageal dilation balloon inflated to 20 cm failed to flop the huge polyp with firm head through pylorus into duodenum.
Then Dr. X who was present during entire procedure tried using a double channel scope and two CRE balloons but even that did not budge the polyp.
SuperCoder Answered Tue 01st of May, 2012 17:34:31 PM
Modifier-22 (Increased procedural service) when the service(s) the physician provides is “substantially greater than typically required.
Its primary purpose is to denote circumstances for which a procedure or service required an “unusual” amount of time or effort to perform.This modifier indicates that a procedure was complicated, complex, difficult, or took significantly more time than usually required by the provider to complete the procedure.
Its use implies that the procedure or service was distinctly more time-consuming or difficult to perform.
More complicated or took significantly, more time than usual to complete.
Send a special report to the insurance carrier that describes the unusual nature of the service and justifies the additional charge.
Modifier 22 should be used to report only procedures that have a 0, 10, or 90 day global period that required a level of work far more extensive than usually necessary for the listed procedure.