Modifier 22

Increased Procedural Services (surgical/procedures codes only)

Instructions

  • Documentation must indicate work performed is substantially greater than typically required
    • Technical difficulty
    • Severity of patient's condition
    • Increased intensity and time
  • Claims paid at profile unless appealed with documentation for appended modifier 22
    • Documentation includes separate paragraph titled Unusual Procedure

Correct Use

  • Report only with surgical procedure codes that have 0, 10 or 90 day global periods
  • Clearly indicate why this case is beyond usual range of difficulty
    • Do not use generalized statements such as: "Surgery took an extra two hours", "Patient was very ill" or "This was a difficult surgery." These statements do not explain why surgery was unusual
  • These issues do not necessarily warrant additional payment:
    • Surgery encountering adhesions
    • Surgery for an obese person
    • Surgery that takes longer than usual to complete
    • Specialized technology (E.g. laparoscope or laser)

Incorrect Use

  • Cannot append to Evaluation and Management (E/M) procedures
  • Inappropriate when procedure took only a few minutes longer than normal

Resource

 

Last Updated Tue, 14 Jan 2020 15:10:08 +0000