Advanced Search

Oncology & Hematology Coding Alert

Easy Access:

Review These Modifier -22 Do's and Don'ts

Published on Sat Sep 20, 2003

Make sure you run through your list of do's and don'ts before submitting your claim for payment and/or into the review process:

 

  • Do include a copy of the operative report with your claim.
     
  • Do check your carrier's local medical review policy before submitting a claim for modifier -22 - not all private payers honor this modifier.
     
  • Do use critical care codes instead of modifier -22 when appropriate.
     
  • Do be sure at least 25 percent more time/effort than usual was required to perform the procedure.
     
  • Do submit your claim on paper - claims for modifier -22 cannot be submitted electronically.
     
  • Do append modifier -22 to assistant-at-surgery procedures.

     

  • Don't append modifier -22 to secondary procedure codes.
     
  • Don't append modifier -22 to E/M codes. Modifier   -22 is only for use with procedural services.
     
  • Don't use modifier -22 for re-operations.
     
  • Don't assume the lysis of an average number of adhesions merits the use of modifier -22.
     
  • Don't report modifier -22 simply because the physician performs a procedure using a lesser-preferred approach.
     
  • Don't substitute an unlisted-procedure code instead for modifier -22 to avoid carrier denials.

    • Other Articles in this issue of

    Oncology & Hematology Coding Alert

    View All