Neurology & Pain Management Coding Alert

Question: Should I always file modifier 22 claims manually? Is there an easier and faster way to submit these claims?
Arkansas Subscriber

Answer: When the work required to provide a service is substantially greater than typically required, modifier 22 (Increased procedural services) may be added to the usual procedure code. Documentation must support the additional work and the reason for it (such as increased intensity, time, technical difficulty of procedure, or severity of patient's condition, or physical and mental effort required).

The vast majority of payers require providers to submit documentation supporting the use of modifier 22. Many payers prefer that you submit the claim electronically and send the documentation separately.

Careful: Some providers indicate in box 19 or the electronic equivalent that -documentation is available upon request.- While some payers have a fax system established for providers to automatically fax in the supporting documentation when the claim is sent, you may wish to include a note with the backup documentation stating: -This is backup documentation to support an electronic claim. This is not a duplicate claim.- This alerts the payer that you are not trying to submit the same claim twice in an effort to double your payment.