tci Outpatient Facility Coding Alert - 2014 Issue 12
Reader Question: Don't Always Count on Time for Modifier 22
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Article Overview
This short coding Q&A discusses modifier 22 in the context of a surgical procedure that took longer than expected because of patient obesity. It summarizes how different payers and CMS frame the issue and outlines broad factors that may support consideration of increased procedural services. The article is useful for coders, billers, and compliance staff who need a general understanding of when modifier 22 may be reviewed under payer-specific policies.
Why This Topic Matters
Modifier 22 can affect how a surgical claim is reviewed, so understanding payer variation and the general types of circumstances discussed here helps support more consistent documentation and claim preparation.
What You Will Learn
- How modifier 22 is discussed in relation to increased procedural services.
- Why payer-specific guidance can affect modifier 22 consideration.
- What broad clinical circumstances are commonly associated with increased procedural intensity or effort.
- How CMS is characterized in general terms on the use of modifier 22.
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Compliance staff
- Physician practice managers
Modifiers Discussed
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