You Be the Coder:
Guidelines for Modifier -22
Published on Mon Apr 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: If one of our surgeons documents exceptional time or difficulty on a procedure, we add modifier -22 and bill with notes. Where can I find written documentation requirements for use of -22?
Ohio Subscriber
Answer: There are few authoritative written guidelines for use of modifier -22 (Unusual procedural services).
CPT notes that this modifier is used "when the service(s)provided is greater than that usually required for the listed procedure" and that submitting a report on the extent of the service may be appropriate.
CMS mentions -22 in Chapter 1 of Correct Coding Initiative version 8.0: "Routine use of the modifier is inappropriate as this practice would suggest cases routinely have unusual circumstances. When an unusual or extensive service is provided, it is more appropriate to utilize the -22 modifier than to report a separate code that does not accurately describe the service provided."
Your local Part B carrier may also have authoritative written guidelines on the use of -22.
Some things to consider when deciding whether to append -22:
1. The surgeon's documentation should be thorough. If the operative report does not indicate the nature of the difficulty or the extra work that was performed, surgeons should not expect carriers to automatically bump up the fee. The documentation should be submitted with the claim, as -22 claims spur an automatic manual review.
2. The additional time and work must be significant. Many coding specialists say that unless 25 percent more work was performed, -22 should not be appended. If your surgeon's operative time is increased 50 percent or more, -22 should be appended. A second diagnosis code may be required to warrant the unusual circumstances.
3. Any additional fees should be charged up front to payers, which are unlikely to raise fees on their own just because -22 is appended.
| |
