Wiki Modifier 22

[kimmcelderry@gmail.com]

Hi there,
Occasionally I am asked to append 22 mod to surgical claims. The only way I've found to get additional compensation is by appealing after the claim has processed. I've tried to research a better way, but payers don't normally explain how best to submit supporting documentation ahead of time. Most experts just say " when submitting your claim, include a copy of the operative report " I've worked for 2 large ortho practices, and neither had the capability of electronically submitting an op note with a claim, so I don't know how to do that. Is appealing the best way or is there a better way of getting 22 reviewed?

 

[csperoni]

In my experience, depending on the carrier, they will either:
1) First pend the claim requesting records. Then reprocess after appeal letter and records are sent.
2) First pay the claim the standard fee schedule amount. We must appeal for the additional payment on -22.
Over the years, I can only recall one small carrier that it was in our contract for -22 to increase payment by a set amount where I did not have to appeal individual claims.
I agree that submitting the op note with the original claim with most software is theoretically possible, but not an easy task. Even if you do submit the op note, if you don't also submit an appeal letter or other information specifying what you are asking for with your -22, I don't know how the carrier could determine the payment amount. -22 tells the carrier it was increased service, but not how much increased service. Sometimes I add -22 because it's 20% more work than usual; sometimes it's 40% more work than usual. My letter tells them what I am seeking and highlights the additional work. On the original claim submission my software allows for a certain number of characters to be attached to the line item where I might put something like "20% increase due to extensive 45 minute lysis of adhesions." But it still requires an appeal letter and records.
To me -22 is similar to using an unlisted code. It's not often used, and when it is, it will slow the payment process. The claim needs to be reviewed manually by a human to determine the payment amount and will take longer than the existing automated systems. However, it is sometimes the only way to receive accurate reimbursement for services provided.
If you do want to submit the information with the original claim, I would direct you to your software vendor for assistance.