Increased procedural service) when the service(s) the physician provides is “substantially greater than typically required.
its primary purpose is to denote circumstances for which a procedure or service required an “unusual” amount of time or effort to perform.
This modifier indicates that a procedure was complicated, complex, difficult, or took significantly more time than usually required by the provider to complete the procedure.
its use implies that the procedure or service was distinctly more time consuming or difficult to perform.
More complicated or took significantly, more time than usual to complete.
Send a special report to the insurance carrier that describes the unusual nature of the service and justifies the additional charge.
Modifier 22 should be used to report only procedures that have a 0, 10, or 90 day global period that required a level of work far more extensive than usually necessary for the listed procedure.
Even when justified, it may be difficult at best to obtain higher than normal reimbursement from the majority of payers.
Modifier 22 is commonly used if
• Surgeries for which services performed are significantly greater than usually required may be billed with modifier 22.
Anatomical Variants
Don’t assign the Modifer 22
If there is no supportive documentation
When there is a existing code available, don’t used moidifer 22
Don’t append modifier 22 to secondary procedure codes.
Don’t use modifier 22 for re operations
Don’t substitute an unlisted procedure code for modifier 22 to avoid carrier denials.
This modifier cannot be submitted with Evaluation and Management (E/M) procedures
This modifier can be used in the following sections of the CPT® code set:
• Anesthesia
• Surgery
• Radiology
• Laboratory and Pathology
• Medicine
Common use Modifier 22
1. Trauma that significantly complicates the particular procedure and cannot be reported with any other procedure
2. Significant scarring that requires extra time and work
3. Morbid obesity making extra work for the physician
4. Increased time resulting from the extra work by the physician
5. Excessive blood loss for the particular procedure
6. Pathologies, tumors, malformation (genetic, traumatic, surgical) that directly interfere with the procedure But are not billed separately
7. Services rendered that are significantly more complex than described by the CPT code in question.
8. Conversion of a procedure from laparoscopic to open, and significant scarring or adhesions.
Example:
The physician performs a colonoscopy on a patient with a tortuous colon. The gastroenterologist spends 110 minutes navigating the scope through the twists and turns of the patient’s lower intestine.
Use Modifier 22 as physician spent extra time.
Documentation:
1) Time: Document additional time
2) Blood loss: Document the quantity of blood lost during the procedure, and compare with usual blood loss during procedure.
3) Use of special equipments
4) Technique used, changing the procedure etc.
Example:
1) During a colonoscopy the gastroenterologist removes nearly 20 polyps from various regions of the colon using hot biopsy forceps technique, physician spends 2 hours for the procedure.
Code 45384 22: Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by hot biopsy forceps/bipolar cautery).
Even when the CPT code describes Polyps (Plural), the physician work exceeded the usually procedure, so append Modifier 22.
Example 2:
The surgeon performs a laparoscopic cholecystectomy with exploration of common bile duct, during procedure, the surgeon encountered multiple adhesions.
The surgeon spends two hours to remove the adhesions.
Code: 47564 22
Modifier 22 is reported as surgeon effort is additional to complete the surgery.
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