# payment on Mod 22



## Lyndapolk (Aug 4, 2008)

Can you please help me understand this.  (My office manager and doctor both agree on this, i do not think they are right on this.)  We billed a LCC with Mod 22 since the procedure ended up being 4 hours long instead of 1 1/2 hours long it was converted to an open procedure.  We billed with mod 22.  I appealed and got an additional payment.  So, the ins paid a total of 125% of allowable.  My doctor wanted me to bill this by tripling the charge so he figures that 125% is not enough.  My office manager seems to think that we should get 3x the allowed amount.  I figure we should get probably 175% of the allowable.  I am not sure how to explain this to them.  Please help me or if you know of a link I can show them.   Thanks.


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## dmaec (Aug 4, 2008)

I'm not real clear by what you wrote - but if the the procedure went to "open", why wasn't the  "open" procedure code used?


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## Lyndapolk (Aug 4, 2008)

I was billed as an open procedure.  I am just wondering how much more will the ins pay for a mod 22 and what are the guidelines in determining how much to be paid?


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## mbort (Aug 4, 2008)

insurance carrier contracts differ, but trust me, you dont get paid three times more just because you bill it that way.  When I add the 22 modifier, I never increase my fee, all that does is increase the write off.  The insurance carriers are going to pay whatever is in your contract for the "extra" work that the -22 modifier was used for. 

I'm sure its not what you wanted to hear..but its reality


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