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tci General Surgery Coding Alert - 2009 Issue 2

Reader Questions: Make Sure You Prove Your Modifier 22 Case

Question: My surgeon performed an excision of a benign 6 cm lesion, including margins. Should I append modifier 22 to 11406 in this case? Florida Subscriber Answer:The answer depends on the scenario and the surgeon's documentation. The descriptor for 11406 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], trunk, arms, or legs; excised diameter over 4.0 cm) clearly states "over 4.0 cm." The only way you should append modifier 22 (Increased procedural services) is if the clinical situation shows that the procedure took extra time and effort compared to other procedures you would...

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