Ob-gyn Coding: Don't Use An Unlisted-procedure In Place Of Modifier 22

By Author: Julia Rose
Total Articles: 89
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Is it ok to go ahead with an unlisted-procedure in place of modifier 22? The answer is no, you should not use an unlisted-procedure code instead of modifier 22. Some coders take this route because they realize the payer must manually review such claims and the carrier's computer cannot deny them automatically. If you walk this route, you could be leading your practice towards lost reimbursement.


Remember that unlisted-procedure codes require the same amount of documentation as modifier 22. To justify the use of an unlisted code and get paid, it takes a lot of extra work on the medical biller's part to submit all the medical records, a letter from the physician and the like.


If you don't include an accompanying narrative with an unlisted procedure code, the Medicare Claims Processing Manual, Chapter 1, Section 80.3.2.1.2, asks carriers to return the claim as unprocessable.


Many a coding experts recommend that you stick with modifier 22 as filling a claim with an unlisted-procedure code takes just as much time and effort and because the reimbursement rates don't appear ...
... to be higher. If the modifier 22 claim meets denial, the ob-gyn still gets paid for the base code. And in case the carrier rejects the unlisted-procedure code, the physician may get nothing and may have to fight for the entire procedure's reimbursement.


For more on ways to ace modifier 22 coding and to get more information on ob-gyn coding know how, you can go for ob-gyn conferences.


In fact if you are looking to attend one, you can head straight to Orlando, FL next month for an ob-gyn coding conference.