Reader Question: Modifier -22

Question: When using modifier -22 (unusual procedural services), should the physician adjust his or her fee on the Health Care Financing Administration 1500 form as well as address the percent increase in the KISS letter (a cover letter that must be sent with documentation in a request for extra reimbursement)? Or should he or she apply the usual fee on the form and request in the letter that the fee be increased by a certain percentage?

R.D. Seirafi, MD
Jasper, Ala.

Answer: List the increase in both places. For example, state that the base fee is $1,000 and that you are requesting an increase of 20 percent. List $1,200 on the claim form and at the top of the letter where you list the fee.

In the summary sentence of the letter, state, Listed fee of $1,200 reflects our requested increase of 20 percent.

The source for this Reader Question is Susan Callaway-Stradley, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C.

- Published on 2000-11-01