Wiki Additional fee for Modifier 22?

[dearobinson]

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

 

[Erica1217]

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

 

[dearobinson]

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!

 

[Erica1217]

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

 

[FTessaBartels]

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