Modifier 22 | Increased Procedural Services Explained

Modifier 22 can be used to report additional work not described by the procedure code alone. It indicates that the physician’s work required to perform a procedure was more than is typically needed. This modifier should only be used in rare and unusual circumstances where the physician’s work required to perform a procedure is significantly more than what is typically needed. The physician must document the reason(s) why the work he performed was more than he typically performs. The documentation should include any or all of the following: increased intensity, additional time, technical difficulty, or severe patient condition.

1. What is modifier 22?

Modifier 22, also known as Increased Procedural Services, is a CPT modifier used to indicate that the physician’s work required to perform a procedure was more than is typically needed. In addition, it is used to report additional work that is not described by the procedure code alone.

2. When to use the 22 modifier?

Modifier 22 should only be used in rare and unusual circumstances where the physician’s work required to perform a procedure was significantly more than what is typically needed. Some examples of situations that might call for modifier 22 include excessive blood loss, the presence of huge surgical specimens, trauma extensive enough to complicate the particular procedure, and other pathologies or tumors that directly interfere with the procedure.

3. Description

The official description of modifier 22 is “increased procedural services.”

It indicates that the physician’s work required to perform a procedure was more than is typically needed.

4. Examples

Some examples of procedures that may require modifier 22 include complex spinal surgeries, extensive skin grafts, and complex abdominal surgeries. These procedures require additional time, effort, and technical skills from the physician.

5. Documentation

To use modifier 22, the physician must document the reason(s) why the work he performed was more than he typically performs.

The documentation should include any or all of the following:

• increased intensity;
• additional time;
• technical difficulty; or
• severe patient condition.

The documentation should also include the average time and effort the physician spends on the procedure to justify higher reimbursement for the unusual procedure.

6. Billing

When submitting claims to the payer, increase the charge for the unusual procedure, and include a copy of the operative report to validate why the procedure was unusual. Modifier 22 only applies to procedure codes in the surgery section. It does not apply to E/M, anesthesia, radiology, pathology, or medicine codes.

Append modifier 22 to major procedures with a 90-day postoperative period or minor procedures with a ten-day or 0-day postoperative period. Do not assign modifier 22 if you could assign an additional procedure code to represent the increased services.

7. Common mistakes

One common mistake that medical coders make when using modifier 22 is appending it to procedures that do not meet the criteria for increased procedural services. Another mistake is failing to provide adequate documentation to support modifier 22. To avoid these mistakes, coders should carefully review the physician’s documentation and ensure that it meets the requirements for using modifier 22.

8. Other modifiers related to modifier 22

Other modifiers related to modifier 22 include modifier 52 (reduced services) and modifier 62 (two surgeons). Modifier 52 indicates that a procedure was partially reduced or eliminated at the physician’s discretion. Modifier 62 indicates that two surgeons worked together as primary surgeons on a procedure.

9. Tips

When using modifier 22, it is essential to ensure that the physician’s documentation supports the use of the modifier. Coders should also be familiar with the criteria for using modifier 22 and ensure that the procedure meets those criteria before appending the modifier.

10. Conclusion

Modifier 22 is a CPT modifier used to indicate that the physician’s work required to perform a procedure was more than is typically needed. It should only be used in rare and unusual circumstances where the physician’s work required to perform a procedure is significantly more than what is typically needed.

To use modifier 22, the physician must document the reason(s) why the work he performed was more than he typically performs.

The documentation should include any or all of the following: increased intensity, additional time, technical difficulty, or severe patient condition. C