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Wiki any tips for using mod.22?

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mabar1571

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I do card.cath.coding/billing and the drs.want to revisit using mod.22 on caths. I was wondering if anyone had any tips or success stories they might share as to what they did to get additional reimbursement using -22.

If a cath.is done and there is truely a legit.reason to ask for additional reimbursement because of time or complexity (or both) what kind of documentation have you all seen that proved the best in getting your claim paid with additional reimbursement and in the most timely manner.

Is a clearly separate paragraph in the cath.report detailing what was done that made the procedure more complicated the best way to go? Does including the additional time it took help? If the doctor sent a letter along with the claim and the documentation helpful? And what kind of additional reimbursement was seen--20% of fee, 50%?

Any help anyone can provide would be most helpful. Thank you.
 
I try to limit the use of modifier 22 to those cases that are truly above and beyond a typical procedure.

The work value of a procedures takes into the account that some procedures will take less work while others take more.

The documentation has to be clear. I have found it helps if the physician documents a separate paragraph specifically noting why this procedure differed from a typical procedure. Maybe it took significantly more time, in which, case it helps to have a comparative statement to how long a 'normal' procedure takes. I think using time is helpful, but you'll have a stronger case if mental effort, complexity, and technical difficulties are included.

I always increase the fee amount on the claim. Watch for some payers not "seeing" the modifier. You have to call to get the rep to send the claim back for review or send in an appeal with the procedure notes. If your doctors do not agree with the reimbursement, you can appeal.

I have read others recommending sending in op notes at the same time as the claim, but we always take care of providing notes on the back end.

Good luck!
 
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