A Healthcare Operations Consulting Company, Coding and Documentation Reviews Audits, Utilization Prior Authorization, Credentialing, Patients Access and Healthcare Financial Management Consulting Company | GoHealthcare Consulting and Business Development,
  • About Us
  • BLOG
  • Testimonials
  • CONTACT US
  • Readers Questions
  • Resources

How to use modifier 22

8/29/2018

0 Comments

 
Definition: Increased Procedural Service requiring work substantially greater than typically required.

The RIGHT WAY:
  • Surgeries where services performed are significantly greater than usual. 
  • Anatomical variants could be an appropriate use of the modifier. 
  • Assistant at surgery claims where a procedure is significantly greater than usual. 
  • Procedures having a global surgery indicator of 000, 010, or 090 on the Medicare Physician Fee Schedule Database (MPFSDB). 
  • Procedures having a global period but not surgical services (i.e. 77761, 77777, 77782).
Inappropriate:
  • Additional time alone does not justify the use of this modifier (very important to KNOW!)
  • Do not use when there is an existing code to describe the service. 
  • We may deny the claim when the documentation supports another existing code. 
  • Do not use to indicate a specialist performed the service. 
  • Not appropriate for an Evaluation and Management (E/M) service.
  • Documentation
Indicate "additional information available upon request" in field 19 of the 1500 Claim Form.

When the modifier 22 is used, two separate documents will be required to support the claim: 
  • An operative report; and 
  • A separate statement indicating how the service differs from the usual

Important Information for Billing and Documentation

Based on Medicare's Guideline of which most payers does follow Medicare's Guideline. So pay attention on this:

If you append a 22 modifier to a procedure you will receive an Additional Documentation Request (ADR) letter requesting medical records to support the use of the 22 Modifier. It is important that both the operative report and a separate concise statement on why it was beyond the normal difficulty be returned with a copy of the ADR letter. Failure to submit the statement and documentation in a timely fashion will result in processing of the claim with the fee schedule rate for the same surgery submitted without the 22 modifier.

Documentation Tips:
When developing a separate statement avoid using a generalized statement. Comments like "patient was obese" or "surgery took longer than usual" or "multiple adhesions" lack specific details which identify why the procedure was beyond the normal difficulties that could be encountered with the procedure. Further, it is important that your operative note supports the statement on why the surgical procedure was beyond the ordinary range of difficulty.

Unassigned Claim
For unassigned claims, an increase in the limiting charge is allowed only when a charge above the fee schedule amount is justified.

Reference CMS Manual Instruction:
The CMS Internet-Only Manual (IOM) Publication 100-04, Chapter 12 , Section 20.4.6 shows the requirements for using this modifier.
0 Comments

Your comment will be posted after it is approved.


Leave a Reply.

    Picture
    ABOUT THE AUTHOR:
    Ms. Pinky Maniri-Pescasio is the Founder of GoHealthcare Consulting. She is a National Speaker on Practice Reimbursement and a Physician Advocate. She has served the Medical Practice Industry for more than 25 years as a Professional Medical Practice Consultant.

    READERS QUESTIONS

    search here


    RSS Feed

    Archives

    June 2022
    May 2022
    April 2022
    March 2022
    February 2022
    October 2021
    July 2021
    June 2021
    February 2021
    January 2021
    October 2020
    September 2020
    August 2020
    July 2020
    June 2020
    April 2020
    March 2020
    December 2019
    February 2019
    September 2018
    August 2018
    February 2018
    January 2018
    December 2017
    September 2017
    August 2017
    June 2017
    May 2017
    February 2017
    October 2016


    Categories

    All
    10 Common Reasons Claims Gets Denied And Reject
    2019 New CPT Codes Medicare Payments For Virtual Services Remote Monitoring Interprofessional Consultation
    Chronic Care Management In 2017 Changes
    Events
    Medical Modifiers
    Pain Management Billing
    Pain Management Billing Codes
    READER'S QUESTION
    Revenue Cycle
    Spinal Fusion Billing And Coding
    When To Use Medicare's ABN Advanced Beneficiary Notice Claim Reporting Modifiers
    You Be The Biller
    Your Be The Coder

    RSS Feed


    BROWSE HERE

    All
    10 Common Reasons Claims Gets Denied And Reject
    2019 New CPT Codes Medicare Payments For Virtual Services Remote Monitoring Interprofessional Consultation
    Chronic Care Management In 2017 Changes
    Events
    Medical Modifiers
    Pain Management Billing
    Pain Management Billing Codes
    READER'S QUESTION
    Revenue Cycle
    Spinal Fusion Billing And Coding
    When To Use Medicare's ABN Advanced Beneficiary Notice Claim Reporting Modifiers
    You Be The Biller
    Your Be The Coder


Services:
Full Revenue Cycle Management 
98% of the time your claims can get paid
Cash flow increase up to 35% in 90 days
​Accounts Receivables Management
Denial Management
Motor Vehicle Cases
Workers Compensation Cases
Prior Authorization Process
Coordination of surgical orders management
Prior-to-insurance eligibility and coverage verification
Utilization and medical policy review
Medical necessity evaluation and screening
Financial clearance process
Patients Access ​
​Patients Registry and Initial Demographic Entry
Patients Scheduling and Confirming Appointments
Coordination of prior-to-encounter orders management
Prior-to-encounter insurance verification
Obtaining Referral 
Obtaining Prior Authorization
Obtaining Peri Operative Orders
Financial Counseling
Insurance Credentialing and Contracting
Payers' Contract Fees Negotiations
Documentation Review
Evaluation and Management Coding Review
Surgical Coding Review
Compliance Program
Office and Surgical Scheduling
(small or huge organization we can easily help you!

Picture

CALL US TODAY:  1 (800) 267-8752
© COPYRIGHT 2019 GoHealthcare Consulting and Business Development LLC. ALL RIGHTS RESERVED.
  • About Us
  • BLOG
  • Testimonials
  • CONTACT US
  • Readers Questions
  • Resources