February 2001 Bulletin

HCFA tells modifier positions

Won’t recognize -60 for Altered Surgical Field; will study -25

The Health Care Financing Administration has issued a memorandum on CPT modifier -60 (Altered Surgical Field) requesting that physicians continue to use the -22 modifier to indicate that the circumstances encountered in a procedure was unusual.

HCFA said that "in 2001, CPT added the -60 modifier for "Altered Surgical Field. We believe modifier -60 was added because surgeons wanted to clarify the factors that should be considered to justify the use of modifier -22 (unusual procedural services), and to remove the discretion of the payers about whether a procedure were indeed ‘unusual.’"

The instruction of the -60 modifier is that it be used on procedures which "involve significantly increased operative complexity and/or time in a significantly altered surgical field resulting from the effects of prior surgery, marked scarring, adhesions, inflammation or distorted anatomy...."

HCFA said that recognition of the -60 modifier will result in its routine use with a variety of procedures that are typically performed in infants (and already valued as being performed in an individual less than 10 kg). "The instructions for the use of the -60 modifier would also add it to procedures such as 27134-8, revisions in total hip arthroplasty," HCFA said. "Again, the value of the additional work is reflected in these codes.

"We also believe that verification of the status of an ‘altered surgical field’ will be difficult for our contractors. Manual review of these claims, which are likely to be more frequent than claims carrying the current -22 modifier, is likely to consume considerable contractor medical review effort with objective verification of the ‘altered surgical field’ [that is] difficult or impossible.

"We believe that the -22 modifier, which requires documentation that the procedure was unusual, is sufficient to allow carriers to adjust the compensation of physician when the service is beyond the expected variation in work of a procedure."

HCFA also said it has received many questions and concerns about a series of Correct Coding Edits that require, for payment, a -25 modifier to be appended to an Evaluation and Management (E/M) Service when that service is billed on the same day as certain XXX global procedures. HCFA said it has the project under review and will announce any changes in these edits when a decision is made.

This particular series of Correct Coding Edits were implemented on Oct. 31, 2000. During the past year HCFA said it sent the proposed edits to medical specialty societies for review and comment before finalizing these series of edits. HCFA said, "this is a correct coding policy. Many XXX global procedures include pre-, intra-, and postprocedure physician work. Unless a separately identifiable E/M service is provided, it is inappropriate to bill separately for physician work already included in the XXX global procedure. Using the -25 modifier with an E/M service identifies the service as separately identifiable from the work associated with the XXX global procedure and will assist physicians in coding their claims correctly.

"When the -25 modifier is appended to the E/M service, then both the E/M service and the XXX global procedure will be paid. If the -25 modifier is not appended then only the XXX global procedure will be paid. Not all XXX global procedures are involved and this requirement is limited to E/M services billed by the same physician on the same patient on the same day as the XXX global procedure."

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