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Modifier 22

Teresa Posted Mon 18th of May, 2020 10:35:08 AM
I have a general question that I can't seem to find an answer for. When the physician uses modifier 22 on a CPT code we append the reasoning in block 19 on the HCFA form. I'm being told that the re-imbursement rate is no different. If this is the case, why would we even bother added the reasoning as to why it's being used to begin with? Some physicians are questioning the RVU re-imbursement rate when using this. I don't have the heart to tell them there's no difference in the rate. I appreciate any input related to this matter Sincerely-Teresa
SuperCoder Answered Tue 19th of May, 2020 04:39:36 AM

Hi Teresa, 

 

Thanks for your question.

 

Usage of modifier 22 may increase your payment but the additional difficulty of the procedure should be detailed in the body of the operative report. If modifier 22 is approved, additional payment as applicable may be made.

 

Moreover, the claims for surgeries billed with modifier “22”, are priced by individual consideration if the required statement and documentation are included. If the required statement and documentation are not submitted with the claim, pricing for modifier “22” is made as the procedure submitted without the “22”.

 

Please feel free to write if you have any question.

 

Thanks.

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