ASGE members may submit coding inquiries electronically to codingquestions@asge.org. When submitting a question, please allow at least three business days for a response. When submitting inquiries, please include the ASGE member’s name and ID number. Only questions will be accepted and no reports. Below is our featured Coding Question of the Month that could be beneficial to your practice.
Question: Is there a resource that identifies the expected or allotted time for endoscopic procedures? We have providers requesting the use of Modifier 22 and are asking for documentation to support our determination that the modifier is not warranted.
Answer: You can reference the Medicare Physician Fee Schedule and download the Physician Work Time file. When reviewing endoscopic procedures, the most relevant benchmark is the intra-operative time listed in the work time column.
For Modifier 22 consideration, you must clearly document the circumstances that resulted in substantially greater work than is typically required for the procedure. While increased procedure time may support the modifier, the reason for the additional time must also be well documented. In general, many payers expect the procedure time to be significantly greater, at least twice the published intra-operative time—before considering additional reimbursement beyond the standard allowed amount.