Wiki Modifier 22

[Hibbs]

I am getting confused with this mod 22, does time always have to be in the docmentation. I am being told that time has to be in the documentation in order to bill for this?

 

[hopepg]

One of the physicians I bill for uses modifier 22 on occasion. He doesn't specify time.

He does dedicate a section of his operative note to explain why modifier 22 is being appended & that additional reimbursement should be received.

He will say specify what he did to warrant the modifier 22 usage & he will always end the section with something to the effect of....."Overall because of the additional work required, this took the case approximately three times as long as is typical for...."

We normally receive the additional allowable, but not always right away. I send reconsideration requests, appeal requests...until I get additional payment or explanation on why the payer isn't allowing the additional.

When you word your reconsiderations/appeals - you will want to specify what the provider said in the operative note or at least reference where the physician documented the additional time involved in the case.

When you are sending reconsideration requests or appeals, you will run into timely issues if they aren't sent within their required timeframe. I keep a spreadsheet to track the activity of these claims easier. The additional work on the biller's part is usually worth the additional revenue to the practice. More importantly, worth it to the physician who did the extra work!

Good luck!

 

[CodingKing]

The documentation should specify what makes it significantly above and beyond what is normally expected during the procedure.

Here's some information from about the documentation

http://www.wpsmedicare.com/j5macpartb/resources/modifiers/modifier22-billing-documentation.shtml

Here's a payment policy from Moda Health with some examples of what does and does not count (see pages 4-5)

https://www.modahealth.com/pdfs/reimburse/RPM007.pdf