tci Outpatient Facility Coding Alert - 2017 Issue 12

Reader Question: Look to This Advice When Appending Modifier 22

Question: We recently submitted a claim where we appended modifier 22 because the surgeon spent an extra 50 minutes on the procedure due to an unforeseen anatomical abnormality that caused complications. But, when the payment came in, it just reflected the standard fee for the surgical code. Do you think we might receive full reimbursement if we appeal the denial? Louisiana Subscriber Answer: For the first submission, payers do not usually pay extra for a surgery appended with modifier 22 (Increased procedural services). An appeal will most often be necessary for the surgeon to receive full reimbursement. According to...

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