Obscure Use for Modifier 22

Hi guys!  I hope you are having a great weekend.

I bet you haven’t heard of this use for modifier 22:

According to the NCCI Manual (Chapter 1 ), if an NCCI PTP edit is assigned a modifier indicator of 0 (NCCI associated modifiers cannot be used to bypass the edit) and the procedure qualifies as an unusual procedural service, the physician may report the column 1 code with a modifier 22.

Yes, you heard that right.  If you have an NCCI edit where a modifier is not allowed to unbundle, but your documentation supports that both procedures should be billed, you can report your column one code with modifier 22. But be prepared to defend  your decision with your documentation.

They use this example to illustrate how this would work:

CMS limits the payment for 69990 (microsurgical techniques, requiring use of operating microscope) to procedures listed in the Claims Processing manual, Pub 100-04 chapter 12 Section 20.4.5. If a physician reports 69990 with another CPT that is not on that list, an NCCI edit will prevent payment of the 69990. In this situation the physician may submit his claim to the local MAC for re-adjudication appending a modifier 22 to the CPT code.  Although MACs cannot override an NCCI edit that does not allow use of NCCI associated modifiers, the MAC has discretion to adjust payment to include the use of the operating microscope based on modifier 22.

Even thought this modifier 22 caveat applies to more scenarios than just 69990, keep in mind that these scenarios would be few and far between.

To review the NCCI manual click here

To review the Claims Processing Manual Chapter 12 section 20.4.5 click here.

I hope this little CMS tip has been helpful for you.

Happy Coding,

Angie

 

Leave a Reply

Your email address will not be published. Required fields are marked *