Correctly Using Modifier 22 in Your Medical Billing

In medical billing, modifiers can be just as important as the CPT codes they append. A simple mistake such as miss sequencing these codes could lead to incorrect reimbursements. There is one modifier that is known as being the most incorrectly used modifier: 22. Modifier 22 (Unusual procedural services) is used to indicate a substantial amount of extra work a physician needs to do for a specific procedure. As a matter of fact, there are some procedures that never get separately reimbursed unless modifier 22 is used in medical billing. The lyses of adhesions are one example of this.

The lyses of adhesions are a procedure that is always bundled with other current procedural terminology codes in medical billing. The only way to bypass this edit is to append the particular medical billing CPT code with modifier 22. When a payer sees this modifier, the claim usually gets thrown into review. Extra documentation is needed to prove that separate reimbursement is needed.

The Centers for Medicare & Medicaid Services has also recently revised documentation requirements for modifiers. Keep in mind that hyphens no longer need to precede modifiers in any document requested or submitted. However, using a hyphen will not penalize you. Sometimes the hyphen is used to merely show a separation between the medical billing code and the appending number.

Medicare will pay for additional work done if there is substantial evidence to back using the medical billing modifier 22. Great documentation is as good as gold in the medical billing world and correct usage of modifier 22 along with strong medical documentation will result in reimbursements for your practice.

View all Articles by: Melissa Clark, CCS-P