How-to Modifier 22 - AAPC Knowledge CenterModifier 22: What You Should Know - Unusual increased procedural services.

Increased procedural services may come into play when a procedure exceeds the normal range of complexity.It doesn't justify appending modifier 22 to the procedure code.

Only rare, outlying cases, when a physician has gone above and beyond the typical framework of a particular procedure, call for modifier 22.It allows the physician to be reimbursed for unforeseen difficulties or additional time spent that is not usually anticipated for the procedure.Getting modifier 22 claims paid requires more than just extra work in the operating room, it also requires a greater effort documenting and submitting the claim, as this article will explain.

There is an increment of work that is not described by another code.Most of the time, it will accompany surgical claims.There are circumstances that call for modifier 22.

There are specific instances when you might use modifier 22 that include large tumors, excessive scarring, and morbidly obese patients.

Support for the claim is dependent on the strength and detail of the report.Your provider deserves more than the contracted rate if they performed at a level beyond the contract.The unusual nature of the service can be established by comparing the difference between a typical procedure and a procedure reported with modifier 22.The description must be included in the surgical documentation.

Details matter.Give the insurer a reason to pay you more.Explain to the provider that in order to receive appropriate compensation, they must document and explain exactly how the service performed differs from the usual.An in depth description of the procedure should be included in the op note.It should specify any unexpected findings or complicating factors that contributed to the extra time and effort spent performing the procedure.

The physician will usually be paid for their additional work if the claim is documented accurately.To facilitate this, when you submit your claim, you should include a copy of the report that documents and justify the unusual service and a brief, concise cover letter.If you send the claim electronically, you may have to include this information in the narrative field.

It's important to ask for more money.When writing your cover letter, state what you consider an appropriate payment amount for the service rendered.If a procedure requires twice the amount of time as is necessary due to unusual clinical circumstances, you could ask the payer to increase the intraoperative portion of the payment by 50 percent.

Only report procedures that the provider spent significant extra time, resources, or mental energy to complete.Don't add modifier 22 to evaluation and management codes.If:, it is not appropriate to use modifier 22.

Payers watch the claims carefully.Be prepared to provide detailed evidence of the extra difficulty encountered in comparison to the work that would normally be expected for the procedure performed.Only when documentation supports a truly extraordinary service can Modifier 22 be applied.Taking steps to make sure your claim is supported will increase your chances of getting paid.

Thank you for the information, can you tell me more about not applying modifier 22 to add on codes?

You should report an evaluation and management code.See the prolongation care codes for additional time outside of the typical E/M service.If the additional work is included in the primary code and not separately reimbursable, you should bill from a facility with a physician-only code.