Wiki Modifier -22

[kschulte71]

If we have documentation to support user of a modifier -22 on a professional claim , should we use it on the facility side as well (we bill for both facility and physician)? Also, should we increase the amount billed or will insurance companies automatically pay a % over the billed price? Just want to ensure we are billing correctly.

 

[thomas7331]

Modifier 22 is for use on professional claims only and is not recognized under OPPS for outpatient facility claims so it will not add anything to your facility reimbursement and in fact could cause some denials or rejects. As to whether or not to increase your charges, that would be a business decision for your facility. But since facilities usually set their fees based on use of facility resources (e.g. amount of time in the OR or recovery room) I think it would not be appropriate to inflate a facility charge based on the professional work by the MD if your facility is already using such a methodology to establish charges. Any extra time or cost incurred by the facility should already be reflected in the charges without increasing them based on the physician's work.

 

[kschulte71]

Thank you!