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Cardiology Coding Alert

Increased Services:

Modifier 22 Claims for Noridian Must Heed This Redetermination Rule

Published on Wed May 09, 2012

Make a point of checking payment to see if you need to take action.If you're coding for a Part B patient in one of Noridian's 10 states, keep that payer's rule for modifier 22 claims in mind.Noridian Administrative Services (NAS) no longer requests additional documentation on codes with modifier 22 (Increased procedural services) appended. You'll have to ask for a redetermination if after NAS pays the claim your practice feels the service deserves higher reimbursement. You must include the op report, a letter, or a "Modifier 22 Explanation Form" with your redetermination request, NAS advises providers. The point is to explain succinctly why the service deserves extra pay by demonstrating that the claimed service took significantly more time and effort than a typical case. Draw clear comparisons between the claimed case and a typical case to support your request, such as, "The procedure required 90 minutes to complete instead of the [...]
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