AAPC - Back to school
Results 1 to 3 of 3

Thread: 22 Modifier

  1. #1
    Join Date
    Apr 2007
    Lafayette Louisana

    Default 22 Modifier

    AAPC: Back to School
    Has anyone ever gotten paid for using 22 modifier? I am the Coding/Billing Coodinator for an Ambulatory Surgery Center and tried the 22 modifier on an obese patient when the surgery took a hour longer than it should have. I submitted the ENTIRE medical record, a letter from the doctor along with the operative report and got paid NOTHING extra. I even specified the reason I was sending all of this information was for the justification for using the 22 modifier. Anyone have any ideas of what more I could have done to get paid ANYTHING extra?


  2. #2

    Smile Modifier 22

    I have used modifier 22 in the past with success. You need to specify the extensiveness of the operation not so much the extra hour. Ask yourself and the Dr. "why did it take longer?" and "What made it more extensive?". Modifier 22 is no doubt harder to get paid extra on, but if you prove to the insurance company that there is substantially a greater service provided; and additional work was completed they should'nt deny that! If you still do not have luck after this, I would appeal it as far as you can go, if you feel that it truly was a substantial extensive amount of work. I have had to go up the levels of appeal in the past to get it paid with success.

    Good luck and keep on trying it will be worth it in the end!

  3. #3
    Join Date
    Apr 2007
    Ogden Utah


    I have had luck getting the 22 modifier paid in quite a few circumstances. The main key to having it paid is to have the doctor state, in their op report, just what made the procedure different than the 'norm', amount of additional time above and beyond standard, and if used, why a different or unique approach was required for this patient's situation. If they have it stated clearly and succinctly in the op report, the justification for the 22 modifier usage has been met.
    Good luck!

Similar Threads

  1. Replies: 2
    Last Post: 09-18-2015, 01:17 PM
  2. Modifier 59 vs Modifier 91 for Laboratory
    By leahrey in forum Modifiers
    Replies: 1
    Last Post: 06-23-2015, 12:01 PM
  3. MODIFIER PT VS MODIFIER 33 Screening Colonoscopy
    By Ann Johnson in forum Modifiers
    Replies: 2
    Last Post: 07-19-2012, 07:08 AM
  4. Modifier 58 versus Modifier 78
    By Ramona03 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-04-2012, 12:10 PM
  5. Modifier 51 Versus Modifier 59
    By Sborkowski in forum Modifiers
    Replies: 3
    Last Post: 05-26-2009, 03:59 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.