BMI: New code choices could support higher coding, but don't assume you need -22

Published: 21st April 2011
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This year's just-in fifth-digit diagnosis codes for BMI help you document a patient's condition better, especially when the patient's BMI might lead to more complex risk factors for the anesthesiologist to handle. However, having documentation of a high BMI does not automatically lead to more payments. Watch two areas prior to assuming you can automatically add modifier 22 (Increased procedural services) owing to BMI and potentially score a 20-30 percent higher pay for the procedure.

Not all morbid obesity means modifier 22

A patient is taken to be morbidly obese when his or her BMI is 40 or more. Just-in BMI codes for this year include:

  • V85.41 -- BMI 40.0-44.9, adult

  • V85.42 BMI 45.0-49.9, adult

  • V85.43 -- BMI 50.0-59.9, adult

  • V85.44 -- BMI 60.0-69.9, adult

  • V85.45 -- BMI 70 and over, adult

    While morbid obesity can be a proper reason to report modifier 22, do not assume that you should always add the modifier just because the patient is morbidly obese.

    Extra time does not always mean more money

    Modifier 22 is about extra procedural work and even though morbid obesity might lead to extra work, it's not enough in itself.

    Unless time is significant or the intensity of the procedure is increased owing to obesity, then modifier 22 shouldn't be added.

    Here's the catch: CPT doesn't provide specific direction on how much time and/or percentage of increased time or work the provider must document to merit modifier 22. However, the rule of the thumb is your provider must spend at least 50 percent more time and/or put in at least 50 percent more effort than normal for you to add modifier 22.

    There should be documentation of at least a 50 percent increase in work and/or time to justify tge use of modifier 22.

    Document: One sure-shot way to demonstrate a procedure's increased nature is to compare the actual time, effort or circumstances to your anesthesiologist's typical time and effort for that particular procedure. A note like "The procedure required 90 minutes to complete, instead of the usual 35-45 minutes" can be useful. Remind your anesthesia providers to clearly document the reason for the increased time and effort in the patient's record.

    As these claims normally require manual review or an appeal in order to get additional payment, be sure the operative note is detailed and specific to support the medical necessity and reasons for the use of modifier 22. An additional letter from the doctor to present the case and the reasons for requesting more payment that is written in layman's terms will help to appeal the claim.

    For more on this and for other specialty-specific articles to assist your anesthesia coding, sign up for a good medical coding resource like Coding Institute.

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