What modifier may be used when a physician reports a procedure that NCCI edits state should not be reported together and documentation supports it as an unusual procedure?

Using modifier 22 is appropriate in scenarios where a physician performs a procedure that is unusually complex or requires significantly more resources than typically expected, especially when the National Correct Coding Initiative (NCCI) edits indicate that two procedures should not be reported together under normal circumstances. The modifier 22 signifies that the service is a unique circumstance, thus justifying the separate reporting despite the usual editing rules.

In this context, if the documentation supports that the procedure performed was unusually complicated or extensive, modifier 22 provides a way for the provider to communicate that to the payer, allowing for a potential increase in reimbursement to match the intensity of the work done. It's essential to have robust documentation to back up the use of this modifier, verifying the reason for the unusual nature of the procedure.

The other modifiers listed serve different purposes and would not be suitable for indicating unusual circumstances in the context of procedures that NCCI edits deem not to be reported together. Each modifier is specific in its use, making it crucial to apply the correct one for accurate coding and billing.