tci Outpatient Facility Coding Alert - 2014 Issue 12

Reader Question: Don't Always Count on Time for Modifier 22

Question: One of my doctors performed a procedure to excise a lesion on an obese patient. Because of the patient’s obesity, the procedure that should have taken 30 minutes, took 45 minutes. Can I code the procedure with modifier 22? Georgia Subscriber Answer: The answer depends on your payer. Some experts say you shouldn’t use modifier 22 (Increased procedural services) unless the procedure takes at least twice as long as usual, where other experts say that the procedure should take at least 25 percent more time and effort. CMS simply states that the modifier should be used...

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