Modifier 22, 22 modifier

Modifier 22 | Description & Billing Guidelines

The 22 modifier can be appended when a physician requires more work than normal for a surgical procedure. Below are the description and billing guidelines for modifier 22.

What Is Modifier 22?

Modifier 22 can be appended to a surgical procedure if the documentation shows one or more of the following reasons;

  1. technical difficulty;
  2. additional time;
  3. increased intensity; or
  4. a severe patient condition.

A severe condition is only appropriate if it makes the surgery dangerous or difficult for the patient and needs more mental/physical effort from the physician.

The reasons above need to be well documented by the physician and have to indicate at least one of the reasons.

This modifier can not be reported when the procedure was only slightly difficult or if it took only a couple of extra minutes. The difficulty needs to be substantially more than the average difficulty of the procedure.

Description

Modifier 22 is officially described by the CPTs manual as: “Increased procedural services.”

Billing Guidelines

This modifier will not be billed often because unusual circumstances only occur in a few cases.

CMS explains that modifier 22 can only be applied to indicate an increment of work that is infrequently encountered for a specific procedural code.

Modifier 22 can be appended to major procedures with a 90-day postoperative period. It can also be appended to minor procedures with a ten or zero-day postoperative period.

Below are some examples of reasons to report the 22 modifier.

  1. Services that are significantly more complex than described by the procedural code.
  2. The presence of excessively large surgical specimens. This can occur in abdominal surgery.
  3. Excessive blood loss.
  4. A particular procedure that is complicated by extensive trauma.
  5. Other pathologies that interfere with the procedure can not be billed separately.
  6. Other circumstances like;
    • morbid obesity;
    • a procedure that is converted from laparoscopic to open;
    • low birth rate; or
    • adhesions or scarring.

This modifier can only be billed for surgeries. Do not append it to codes from other chapters.

Modifier 22 can not be appended to a procedure code if there is an add-on code that described the additional services.

Think about the following when you submit a claim to a payer:

  1. include a copy of the operative report to prove that the procedure was unusual;
  2. increase the charge of the procedure;
  3. justify the higher reimbursement with a documentation that shows the average time spent on the unusual procedure.

Go back to the complete list of CPT modifiers.


Resources

https://www.aapc.com/discuss/threads/removal-femur-rod-difficult-case.181282/

https://www.aapc.com/blog/24809-modifier-22-is-the-exception-not-the-rule/

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