When a provider uses the 22 modifier for increased time and effort due to obesity, is it required to document the BMI? If so, where should this be documented. This is What was documented in the op report: Findings: I am adding a 22 modifier to this case due to the added increased work required due to her morbid obesity. There was 50 to 75% greater effort causing technical difficulty increase time and mental effort in order to place this femoral implant. This case took at least 2 hours longer than it should take.