As the description implies, modifier 22 should not be reported with Evaluation and Management services.
The official description of the 22 modifier is: “Increased Procedural Services.”
The 22 modifier should only be reported with procedure codes that have a global period of 0, 10, 90 days, or YYY as identified on the Medicare Physician Fee Schedule Relative Value File. In unusual circumstances, Modifier 22 would be applied to surgeries that took significantly more time than usually required by the provider to complete the procedure, which includes increased intensity, time, technical difficulty of the procedure, and severity of the patient’s condition.
An operative report is attached to the claim at the initial submission itself. Failure to submit the corresponding Medical records would result in denial with the following messages.
Claim Adjustment Reason Code 16– Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
Remittance Advice Remark Code N102 – This claim has been denied without reviewing the medical record because the requested records were not received or were not received timely.
Modifier 22 Reimbursement Percentage
The Modifier 22 Reimbursement Percentage would be increased to 20 to 30 percent than the actual allowable. If the operative report attached to the claim does not indicate appropriate use of the modifier, the 20 percent to 30 percent increase in payment is denied.
Do not use Modifier 22 to report procedure(s) complicated by adhesion formation, scarring, and/or alteration of normal landmarks due to the late effects of prior surgery, irradiation, infection, very low weight (i.e., neonates and infants less than 10 kg) or trauma.