Ask Dr. Z

The provider treated a Type C Lesion of the LAD that had 58mm of the lesion length treated with 3 stents (Prox LAD, Prox to Mid LAD and Mid LAD). In the Medicare LCD prior to 10/1/2022, they stated use of modifier 22 was justified only if 4 or more stents were placed in a single vessel. They did not address Lesion Type or Length. I had always been taught that a 22 modifier could be used when 3 or more stents are placed in a single vessel when factoring in lesion length and/or lesion type. Do you feel modifier 22 justified in this case? What recommendations/rule of thumb should be followed when considering Lesion Length and/or Type to justify modifier 22 use?