22 - JE Part A

Increased Procedural Services (surgical/procedures codes only)

Instructions

• Documentation must indicate work performed is substantially greater than typically required
  • Technical difficulty
  • Severity of patient's condition
  • Increased intensity and time
• Claims paid at profile unless appealed with documentation for appended modifier 22
  • Documentation includes separate paragraph titled Unusual Procedure

Correct Use

• Report only with surgical procedure codes that have 0, 10 or 90 day global periods
• Clearly indicate why this case is beyond usual range of difficulty
  • Do not use generalized statements such as: "Surgery took an extra two hours", "Patient was very ill" or "This was a difficult surgery." These statements do not explain why surgery was unusual
• These issues do not necessarily warrant additional payment:
  • Surgery encountering adhesions
  • Surgery for an obese person
  • Surgery that takes longer than usual to complete
  • Specialized technology (E.g. laparoscope or laser)

Incorrect Use

• Cannot append to Evaluation and Management (E/M) procedures
• Inappropriate when procedure took only a few minutes longer than normal

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 40.2 - Billing Requirements for Global Surgeries - Unusual Circumstances