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payment on Mod 22

  1. Default payment on Mod 22
    Medical Coding Books
    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.

  2. #2
    Duluth, Minnesota
    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?
    Donna, CPC, CPC-H

  3. Default
    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?

  4. #4
    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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