Keep This Checklist Close at Hand to Nail Your -22 Claims
4 simple tips will build a stronger case for unusual-procedure charges If you plan to submit a claim for an unusual procedure, you should pay close attention to a few simple documentation requirements to help you avoid denials. Following is a simple checklist for you to use for every modifier -22 (Unusual procedural services) case you come across:
Tip: Make sure your pulmonologist remembers to clearly document the procedure he performs so you have supporting evidence for your claim. Then, before sending your claim, underline the information in the op note that explains the unusual procedural services. Remember: Due to electronic claim submission requirements, you won't send in the documentation until after the carrier denies your claim "pending further information."
Hint: Make sure you underline, not highlight, so the carrier can easily locate the important parts of the op note, Efstratis says. Sometimes, highlights won't show up when you fax the notes.
One more possibility: Make things easy on yourself by including a separate section on your operative note for special circumstances - this way your pulmonologist can include all the pertinent information.
Watch out: Some carriers require physicians to complete a specific form that they send with claims using modifier -22, so check with your carriers to see if such a form is available. The form will ask for all the necessary information for the carrier's claim review.
