The following decision tree will help you decide whether the application of modifier -22 (increased procedural services) would be appropriate in cases where the provider's work exceeded the norm.
Clinical documentation, Hospital outpatient, Physician practice
Modifier -22 (increased procedural services) frequently causes compliance headaches for revenue cycle professionals. This explanation form may be used to clarify the need for additional reimbursement in complex surgical cases where physician work exceeded the norm.
The following is a match game featuring ICD-10-CM codes for holiday mishaps. Match each ICD-10-CM code with its appropriate code description. Answers are found on p. 2.
This sample debridement query was provided by Jera Van Damme, BSN, RN, CCDS, senior clinical documentation educator at Essentia Health in Duluth, Minnesota.
This sample has been reviewed and approved by ACDIS’ Forms & Tools Library Committee. The committee recommends that, should you choose to use this sample, you adapt it to your programmatic needs, EHR system requirements, and organizational diagnostic criteria. Before sending this query, the first set of asterisks on the form are to be replaced with the provider’s name, the second set should be replaced with the clinical indicators for that patient, the third set should be replaced with the question at hand, and the fourth set should be replaced with the CDI professional’s name and contact information. Additionally, to allow for accurate coding, those wishing to adapt this query may wish to add the following specifics:
Site of debridement
Type/description (excisional or non-excisional)
Depth (deepest layer debrided—i.e., skin, full or partial thickness, subcutaneous tissue, muscle, or bone)
Tissue removed (devitalized)
Instrument used (scalpel, blade, scissors, etc.)
Appearance and size (character of wound—before and after debridement, include pre/post debridement measurements)
The following is a case scenario featuring ICD-10-CM codes for opioid overdose. This scenario was provided by Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, ICD-10-CM/PCS, trainer and procedural coding, compliance, data charge entry, and HIPAA privacy specialist. Webb’s coding specialty is OB/GYN office and hospitalist services, maternal fetal medicine, OB/GYN oncology, urology, and general surgical coding. She can be reached via email at webbservices.lori@gmail.com. You can also find more coding information from her at http://lori-lynnescodingcoachblog.blogspot.com/.
