Wiki payment on Mod 22

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Lyndapolk

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Can you please help me understand this. (My office manager and doctor both agree on this, i do not think they are right on this.) We billed a LCC with Mod 22 since the procedure ended up being 4 hours long instead of 1 1/2 hours long it was converted to an open procedure. We billed with mod 22. I appealed and got an additional payment. So, the ins paid a total of 125% of allowable. My doctor wanted me to bill this by tripling the charge so he figures that 125% is not enough. My office manager seems to think that we should get 3x the allowed amount. I figure we should get probably 175% of the allowable. I am not sure how to explain this to them. Please help me or if you know of a link I can show them. Thanks.
 
I'm not real clear by what you wrote - but if the the procedure went to "open", why wasn't the "open" procedure code used?
 
I was billed as an open procedure. I am just wondering how much more will the ins pay for a mod 22 and what are the guidelines in determining how much to be paid?
 
insurance carrier contracts differ, but trust me, you dont get paid three times more just because you bill it that way. When I add the 22 modifier, I never increase my fee, all that does is increase the write off. The insurance carriers are going to pay whatever is in your contract for the "extra" work that the -22 modifier was used for.

I'm sure its not what you wanted to hear..but its reality
 
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