decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Answer_Book / Surgery_Multiple / Use_modifier_-22_to_get_extra_review_of_a_claim
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Article Overview
This article discusses a surgery coding claims-review issue and explains the circumstances under which a modifier-based request may be submitted for additional payer review. It is intended for coders, billers, and physicians who need a general understanding of how claims involving same-day multiple procedures may be flagged for manual consideration. The article covers broad documentation and review considerations without providing a full coding reference.
Why This Topic Matters
Understanding this topic helps billing and coding staff recognize when a claim may need extra supporting documentation and manual payer review, which can affect processing time and reimbursement review.
What You Will Learn
- How a modifier-based claim review request is framed in the context of surgery coding
- Why additional documentation may be associated with certain same-day procedure claims
- What broad role the payer plays in reviewing claims that are flagged for manual consideration
- How claim processing may be delayed when manual review is requested
Who Should Read This
- Medical coders
- Medical billers
- Physicians
- Revenue cycle staff
Modifiers Discussed
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