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High BMI: To Use Or Not to Use Modifier 22

The new fifth-digit diagnosis codes for body mass index (BMI) can help you better document a patient’s condition, especially when the patient’s BMI might contribute to more complex risk factors for the anesthesiologist to handle. Having documentation of a high BMI doesn’t automatically lead to more pay, however. Watch two areas before assuming you can automatically append modifier 22 (Increased procedural services) because of BMI and potentially score a 20-30 percent higher pay for the procedure.

Not All Morbid Obesity Means Modifier 22

A patient is considered to be morbidly obese when his or her BMI is 40 or more. New BMI codes for 2011 include:

  • V85.41 — Body Mass Index 40.0-44.9, adult
  • V85.42 — Body Mass Index 45.0-49.9, adult
  • V85.43 — Body Mass Index 50.0-59.9, adult
  • V85.44 — Body Mass Index 60.0-69.9, adult
  • V85.45 — Body Mass Index 70 and over, adult.

While morbid obesity can be an appropriate reason to report modifier 22, don’t assume you should always append the modifier just because the patient is morbidly obese.

Example 1: During surgical procedures that are performed because of morbid obesity (such as bariatric surgery), the patient must meet the morbidly obese criteria too support medical necessity for the procedure. In those type instances, simply having a patient who is morbidly obese doesn’t support using modifier 22. Remember, if you report a physical status modifier for a patient who is morbidly obese, it is not appropriate to also include modifier 22. Keep in mind that Medicare does not pay for physical status, qualifying circumstances, or extra work modifiers.

The anesthesia provider’s documentation should direct you to the correct BMI code as well as support when you can append modifier 22.

Example 2: The patient’s obesity might contribute to breathing problems that lead to lower oxygen and…

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Unlock Pay With Anesthesia V Code Advice

Don’t be caught asleep: Patient history is one element of proper Dx coding.

Many coders hesitate to report V codes, or simply use them incorrectly, but sometimes this section of ICD-9 most accurately describes the reason for the patient’s condition….

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Mind Your P Modifiers or Leave Money on the Table

Have your documentation ready for reporting level P4 and higher.

Physical status modifiers, also referred to as P modifiers, PS modifiers, ASAs or ASA P codes, are an important element of your anesthesia coding. If you don’t use them correctly,…

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Anesthesia Coding Education: Combined Spinal Epidural

Question: Our anesthesiologists sometimes mark our C-section tickets as “combined spinal epidural,” but our billing system will only allow us to choose epidural or spinal. Where can I find information about spinal epidurals and how to correctly code them?
Answer: From a coding perspective, whether your physician used spinal or epidural anesthesia doesn’t matter as long […]

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Pain Management Coding Update: Facet Joint Injection CPT Changes for 2010

Pain management, anesthesia, orthopedic, physiatry & neurology coders get ready for a facet joint codes shift that preps for ICD-10.
The 2010 version of CPT attempts to organize the facet joint injection codes by deleting 64470-64476 and debuting 64490- 64495 in their place, as follows:
• 64490 — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves […]

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Anesthesia Coding Education: Sciatic Nerve Block & Same-Day General Anesthesia

Question: My anesthesiologist performed a sciatic nerve block for a patient with postoperative pain on the same day he provided general anesthesia for that patient’s knee surgery. How should I code this?
Answer: Use modifier 59 (Distinct procedural service) when you need to show that your physician performed two distinct services on the same day. When […]

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