Mod 22 is on the "hit list"
You may want to let your doctor know that modifier 22 is on the "hit list" for insurers. It is a modifier that, by it's nature, lends itself to abuse. When I review a modifier 22 to decide if additional $$ is warranted, I look first for several of the common "offenders" for ob/gyn surgery:
-Extensive lysis of adhesions (note the use of the word "extensive"). Also, a provider cannot just state in a letter or at the end of the operative report "extensive". The operative report must detail the extent and location of lesions. It is also helpful, but not necessary, to have the amount of additional time it took to lyse these.
-Morbid obesity. This in and of itself is not a reason I allow modifier 22, but if it is clear that this caused additional work/time beyond minimal additional effort, I will usually allow.
-Previous gyn surgery. This can obscure normal anatomical landmarks and anatomy, making dissection more tedious/difficult.
I would let your surgeon know that he might not want to get to "happy" with a modifier 22. Really, anything that adds less than about 20% to the time/difficulty factor should not be reported. I don't know what the actual amount of claims appended with modifier 22 "triggers" a flag, but believe me, this is not a place that he wants to go. From that point on, everything is scrutinized by the payer, and you are never given the benefit of the doubt.
Good luck!
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PB