General Surgery

I have a physician whom states that there is a code to use for a long hard case. Is anyone familar with what he is speaking of??? Is there an E & M code or does one use the unspecified procedure code that ends in "99" and submit a narrative?
Thanks much!

general surgery

He may be referring to modifier 22. This is for increased procedural services but he better have the documentation ready to prove it. Most of the time, Medicare and most payors require documentation along with the claim form to justify use of this modifier.

I can't resist...

Does that have to do with the warning you get at the end of Viagra commercials...if you have an erection lasting more than 4 hours contact your physician?

Long Hard Case

You can use a 22 modifier on the main procedure, and charge an additional 25 % on the price of the main procedure. If the documentation states the difficulty of the case and time the total surgery took. Submit the Op Report with the claim or wait until insurance requests it, wanting the information. Usually when they see a 22 they will request information. If they deny the additional payment you could appeal it with a letter written by the Surgeon stating the difficulty in the case. Depending on the case.

modifier 22

There's a great article by Alyce Kalb in Codapedia about the use of modifier 22. Type modifier 22 into the search box above "look it up" and you'll find it.