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Thread: use of modifier 22

  1. #1

    Default use of modifier 22

    AAPC: Back to School
    We are having great debates on what constitutes use of mod 22 for colonscopies and EGD procedures. One doctor says he was told if it normally takes him 30 minutes to do a colonoscopy and it takes him an hour (because of a spastic redundent colon for example) he could use mod 22. Or if he took off 15 polyops as compared to the normal 3-5, he wants to use mod 22. I was told by a Medicare Auditor a long time ago to think of mod 22 as the "oh my God" factor, that when a claims processor reads a report with a mod 22 attached their reaction would be "oh my God!!" I'm thinking that my endo docs want to overuse this modifier which I told them would raise a red flag with insurances and cause us to be audited. Any thoughts?

  2. #2
    Join Date
    Apr 2007
    Kokomo, IN

    Default Mod 22

    I agree with you. This is one of those that should be used sparingly. I have used it only a few times and the report must document everything in detail as to what was done and why, what was out of the ordinary and the time, equipment, and extra resources used. It's also a major hassle for you to have to send (not that that's here nor there), you do what you have to do. But, it would definitely raise a red flag if used too often, and with all the lettered companies looking at everything we do, I'd be very leary of using this very often.
    My opinion only.

  3. #3
    Join Date
    Apr 2007
    North Carolina

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