decisionhealth Newsletters, Coder Pink Sheets - 2000 Issue 7 (July)
Cover letter with -22 modifier might help get you paid, but can slow down claim
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Article Overview
This article addresses a practical orthopaedic coding and reimbursement issue: whether to accompany claims involving modifier -22 with a cover letter or include narrative details directly on the claim. It reflects coder and consultant perspectives on claim submission workflow, documentation support, and payer review expectations, with examples drawn from complex procedures and revision surgery. The piece is relevant to coders, billing staff, and practice managers who handle claims that may require additional documentation support.
Why This Topic Matters
Modifier -22 claims can trigger extra scrutiny, so the way supporting information is presented may affect claim processing and follow-up workload. The article helps readers understand common submission approaches and why practices differ in handling these claims.
Article Sections
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Cover letter with -22 modifier might help get you paid, but can slow down claim
Introduces the claim submission question surrounding additional documentation for more complex procedures and why different practices handle it differently.
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Coder and consultant perspectives on documentation submission
Summarizes differing opinions from coders and consultants on whether to attach a cover letter or place narrative details within the claim, along with the general rationale for each approach.
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Example involving ACL revision
Provides a procedural example used to illustrate the type of supporting information practices may include when submitting claims that require extra documentation.
What You Will Learn
- How practices may document claims that need additional support
- Why submission workflow can vary by payer and office preference
- What kinds of broad claim details are commonly discussed for more complex procedures
- How coder and consultant viewpoints can differ on documentation format
Who Should Read This
- Medical coders
- Orthopaedic billing staff
- Practice managers
- Revenue cycle staff
- Physician office staff
Codes Discussed
Modifiers Discussed
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