Medicare Compliance & Reimbursement - 2017 Issue 12
Reader Question: Look to This Advice When Appending Modifier 22
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Article Overview
This article addresses a subscriber question about a surgery submitted with modifier 22 and the follow-up steps that may be needed when payment is not adjusted as expected. It explains the general role of documentation, electronic submission, paper backup copies, and appeals in the context of complex surgical cases. The piece is aimed at coders, billing staff, and surgeons who handle claims involving increased procedural services.
Why This Topic Matters
Claims involving increased procedural services can be difficult to process correctly, and incomplete support can delay payment or trigger an appeal. This article helps readers understand the documentation and claim-handling issues that commonly arise with modifier 22 cases.
Article Sections
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Question
Introduces a subscriber scenario involving a surgery claim and a concern about payment review. The section frames the billing issue that the rest of the article addresses.
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Answer
Summarizes general guidance on documentation, claim submission, and appeals for cases involving increased procedural services. It also discusses the importance of operative note detail and the types of circumstances that may lead to closer payer review.
What You Will Learn
- How modifier 22 cases are commonly supported in claims processing
- Why documentation is important when a procedure is reported as increased procedural services
- What general information is often included when pursuing an appeal
- How operative note detail can affect payer review of complex surgical services
Who Should Read This
- Medical coders
- Billing specialists
- Surgeons
- Practice administrators
- Otolaryngology practices
Modifiers Discussed
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