Results 1 to 3 of 3

Use of 22 and 76 modifiers.

  1. Default Use of 22 and 76 modifiers.
    Clearnace Sale
    As a new coder, CPC-A, to the orthopedic world, I am confused at how my office uses the modifiers of 22 and 76. I am told to enter a repeat surgery with a 22 modifier, and as I explained to the noncertified office manager, there has to be special circumstances with this modifier. It is just not unusual that a repeat surgical procedure is being done-is it being done for some reason.

    Perhaps this is the way the insurance industry wants it; I do not know. But being taught one way and having to forget what I have been taught is extremely frustrating.

    Any suggestions?

  2. #2
    Tacoma Washington
    Modifier -22 is used in circumstances where the service provided was greatly above what is typical for that procedure regardless of the carrier. For repeat procedures I would look at 58, 76, 77 or 78. With the information you gave I would not deem -22 as appropriate.

  3. #3
    If it is the case that the insurance carrier wants you to bill a certain way that is not correct coding, you need to have that in writing. Once you have it in writing you can do it but it needs to stay on file in your office in the event of an audit. It should probably be kept with the contract for that insurance so everything is together. You are correct by coding guidelines that you would not put a -22 on a surgery just because you are repeating the procedure. Show your manager appendix A in your CPT manual and it will give a description of how you should use the specific modifiers. You can also find more info from Medicare's website. If you follow Medicare's criteria you will most likely be covered (at least from a coding standpoint since they are the most strict) that you were trying to do everything possible to stay within coding guidelines and bill appropriately. Hope that helps.

Similar Threads

  1. Modifiers - injection code
    By ryleeq92 in forum General Discussion
    Replies: 2
    Last Post: 03-17-2015, 09:51 AM
  2. Two Modifiers, Which goes first
    By Candice_Fenildo in forum Modifiers
    Replies: 3
    Last Post: 12-27-2013, 04:11 PM
  3. Modifiers -51 and -25
    By hthompson in forum Modifiers
    Replies: 5
    Last Post: 11-02-2011, 12:11 PM
  4. Q modifiers
    By PLAIDMAN in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 01-27-2010, 06:01 AM
  5. IR modifiers
    By carriebeth in forum Interventional Radiology
    Replies: 1
    Last Post: 06-11-2009, 11:44 AM

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.