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?

The use of modifier 22 is appropriate in this context because it specifically indicates that the work performed was significantly greater than what is normally required for a procedure. When a physician encounters a situation where a procedure is considered unusual or exceeds typical expectations, and this is supported by documentation, applying modifier 22 helps convey the complexity, additional time, or effort involved.

In scenarios where NCCI (National Correct Coding Initiative) edits suggest that two procedures should not be reported together, modifier 22 serves as a useful tool to justify the rationale for reporting the unusual procedure when sufficient documentation supports the necessity of the claim. This modifier helps ensure proper reimbursement reflecting the complexity of the service provided, which is essential in cases where a standard coding approach may not fully capture the nuances of care delivered.

Other modifiers, while relevant in different circumstances, do not specifically convey the need for additional explanation of complexity in the same manner as modifier 22. For example, modifiers 25 and 59 focus on distinct procedural service and separate encounters, respectively, which do not apply to unusual procedure claims. Modifier 51 is utilized for multiple procedures and does not address the need for justification of increased complexity. Thus, modifier 22 is the correct choice for denoting an unusual procedure supported by documentation