Wiki 22 Modifier

[grnis7]

Has anyone ever gotten paid for using 22 modifier? I am the Coding/Billing Coodinator for an Ambulatory Surgery Center and tried the 22 modifier on an obese patient when the surgery took a hour longer than it should have. I submitted the ENTIRE medical record, a letter from the doctor along with the operative report and got paid NOTHING extra. I even specified the reason I was sending all of this information was for the justification for using the 22 modifier. Anyone have any ideas of what more I could have done to get paid ANYTHING extra?


Thanks
Gail

 

[tmoore0214]

Modifier 22

I have used modifier 22 in the past with success. You need to specify the extensiveness of the operation not so much the extra hour. Ask yourself and the Dr. "why did it take longer?" and "What made it more extensive?". Modifier 22 is no doubt harder to get paid extra on, but if you prove to the insurance company that there is substantially a greater service provided; and additional work was completed they should'nt deny that! If you still do not have luck after this, I would appeal it as far as you can go, if you feel that it truly was a substantial extensive amount of work. I have had to go up the levels of appeal in the past to get it paid with success.

Good luck and keep on trying it will be worth it in the end!

 

[chelsey71]

I have had luck getting the 22 modifier paid in quite a few circumstances. The main key to having it paid is to have the doctor state, in their op report, just what made the procedure different than the 'norm', amount of additional time above and beyond standard, and if used, why a different or unique approach was required for this patient's situation. If they have it stated clearly and succinctly in the op report, the justification for the 22 modifier usage has been met.
Good luck!