Question -22 modifier on ALL procedures?


Temple, TX
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Hello all! We have a surgeon who is submitting the -22 modifier on every procedure they perform during the surgical encounter. Has anyone seen this? We have conflicting information - report the modifier on the primary procedure only, report the modifier on the procedure that the documentation states was the MOST difficult and why OR submit as documented with the modifier on ALL the surgical procedures performed. I have not been able to locate anything that directs how to report. Only the directive that the -22 modifier goes on a surgical procedure that has a global period of 0, 10 or 90 days. Can anyone lead me in a direction to help????
Hi, no I personally have never seen that, although sometimes I have seen it on 2 cpt codes when 3 or more have been performed. I don't see anything in the Medicare claims processing manual or in our own guidelines that states in can only be applied to one code; however, the documentation would need to support applying it to all the codes. I checked a few payer policies as well and not seeing anything regarding this. What is the surgeon documenting in their mod 22 statement?
Every case and every CPT will not support or require this. Just because a case takes longer, was difficult, or the surgeon doesn't "like" the reimbursement rate for a procedure doesn't warrant appending this to every single line. If you google it you can find endless information on the correct and incorrect use of this modifier.

a) Modifier 22: Modifier 22 is defined by the “CPT Manual” as “Increased Procedural Services.” This modifier shall not be reported unless the service(s) performed is (are) substantially more extensive than the usual service(s) included in the procedure described by the HCPCS/CPT code reported.

Only rare, outlying cases — when a physician has gone above and beyond the typical framework of a particular procedure — call for modifier 22.

"Documentation must support the substantial additional work and the reason for the additional work"

Surgeries for which services performed are significantly greater than usually required may be billed with modifier 22 added to the CPT code for the procedure.

Some great references and answers already provided.
I'm reading this as there are 2 possible questions you are asking.
1) Can a surgeon always put -22 on the surgery? No. You can't possible state everyone was more complex than normal. You can't have everyone be more than normal. That just means you don't know what normal is.
2) Can a surgeon put -22 on multiple CPTs the same surgical encounter? Yes, it's possible. It would certainly be a really, really unusual situation. When it is used, it is typically on the primary procedure only. I suppose there are situations were it could be appropriate on multiple procedures, but I can't recall every seeing a case where that would be warranted.
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Great points! I agree, I have coded many cases where the 22 was properly and clearly documented and supported. However, in 20+ years, I don't think I have ever appended a 22 modifier on every single line item on a multi-line claim.