tci General Surgery Coding Alert - 2002 Issue 8

Modifier -22: Use Cautiously for Compliance and Reimbursement

Correctly appended, modifier -22 (Unusual procedural services) can significantly increase reimbursement for unexpectedly difficult or time-consuming procedures. Because insurers monitor such claims closely and specify strict guidelines for modifier -22's use, you should apply the modifier with caution. Use Sparingly According to a May 1992 CMS directive, modifier -22 is used to indicate "an increment of work infrequently encountered with a particular procedure" that is not described by another code. In other words, it informs the carrier that unusual circumstances and/or complications greatly increased the work required to perform the procedure. For example, emergencies that complicate care and result...

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