Wiki Modifier 22

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I think it's kind of difficult to have a basic letter for -22 since it can be used for a variety of reasons.
In my practice, it is typically used for extensive lysis of adhesions. In our cases, we use 30 minutes of lysis as the threshold for -22. we request additional 20% payment for 30 minutes; additional 30% for 45 minutes; additional 40% for 60 minutes. Below is a sample of a letter for that reason. PLEASE NOTE: there is varying advice as to how much time justifies -22. We use 30 minutes, but many other practices may use a higher minimum time.


Our office recently received a request for medical records on the above claim due to modifier 22 for extensive services on 58661. Following are the operative notes for PATIENT'S surgery.

Due to both extensive lysis of adhesions for 90 minutes and radical pelvic dissection, this salpingo-oophorectomy was much more complex than typical, warranting the modifier 22. PATIENT had an 11cm endometrioma with bowel draped over it. There were dense adhesions of both the bowel and the endometrioma to the bladder and to the uterus. The sigmoid and bladder were oversewn during the procedure due to the adhesions. As a result of the additional time and skill required to perform this challenging surgery, I am requesting payment for 58661 at 150% of our allowable. Please contact me with any questions or issues regarding this matter. I can be reached directly at (###) ###-#### or e-mail: YOU@YOUREMAIL. I look forward to your prompt review and resolution of this claim.
 
I would also recommend you putting in a calculation of what you are expecting for your additional payment. I have this table in all my 22 modifier appeal letters.

Allowed amount $****.** x120%=$****.**; Amount owed $***.**
The percentage will vary based on the carriers increased payment policy. The amount owed would be the difference.
 
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