Modifier 22

Increased Procedural Services

Instructions

Documentation to indicate that the work performed to provide the service was substantially greater then typically required.

  • Must support the substantial additional work
  • Reason for the additional work
    • Increased intensity
    • Time
    • Technical difficulty of procedure
    • Severity of patient's condition
    • Physical and mental effort required
  • Documentation includes separate paragraph titled Unusual Procedure
  • Should not be appended to an evaluation and management service

Correct Use

  • Report with surgical procedure codes with a 0, 10, or 90-day global period
  • Clearly indicate the difficulty of the procedure beyond the norm
  • Submit explanation with claim. Additional documentation no longer requested.

Incorrect Use

  • Do not use generalized statements, such as:
    • Surgery took an extra two hours
    • This was a difficult surgery
    • Surgery for an obese patient

Special Appeals Process

When submitting the Reconsideration request, include a separate, concise statement explaining the substantial additional work done and the reason for medical necessity for this additional work.

Resource

Last Updated May 22, 2018