• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Additional fee for Modifier 22?

D

dearobinson

Guest
Messages
3
Location
Englewood, Colorado
I need some guidance on what additional fee to charge when appending with -22. Would it be reasonable to charge half of the procedure fee?

Thanks!

Dea Robinson, MA, CPC:confused:
 
It depends on the circumstances. Why are you using the modifier -22? Did the surgery take and extra hour? Twice as long as normal? If you and the provider feel the extra work & effort is worth an extra 20%, charge that... if you feel it's worth double your usual reimbursement, then charge that. It just all depends. There is not one answer for this question.

:) Erica
 
In this instance, a hysterectomy, the uterus was pathologically large and took extra time to remove. Sounds like I could get an idea of how much longer it took and do some kind of percentage off the original procedure code when I append it.

Thanks!
 
I've had luck getting about an additional 20 - 25% for each extra hour of work (depending on payor). Your doc should be documenting the nature and time of this extra / unusal work or your appeals will most-likely not be successful.

Good luck!

:) Erica
 
Usually 25%

When we use the -22 modifier for an exceptionally difficult or long case, we typically increase our fee for that procedure by 25%. (Sometimes a bit more, sometimes a bit less.)

F Tessa Bartels, CPC, CEMC
 
You must log in or register to reply here.
Top