tci General Surgery Coding Alert - 2009 Issue 10

Reader Questions: 50 Percent is the Modifier 22 Rule of Thumb

Question: If the surgeon states a large area was debrided and the debridement codes are relative to depth, how do you determine if the area size justifies modifier 22? Louisiana Subscriber Answer: Payers will not likely view a statement that surgeon debrided a large area (or even that he debrided over ____ cm2 of tissue) as sufficient documentation to secure additional reimbursement for the debridement procedure using modifier 22 (Increased procedural services). Most coders have found that in order to get additional reimbursement for modifier 22 the physician must describe additional time--for example, "twice as much time as normal"...

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