Get Modifier 22 Explanation Form

Modifier 22 is reimbursed by adjusting the payment based on the documented complexity and additional work involved in the procedure. After submitting a claim with the modifier, payers review the provided documentation in the Modifier 22 Explanation Form to determine the appropriate additional reimbursement. Each insurance company may have its own policy regarding how they handle claims with modifier 22, so it is essential to understand these guidelines. Proper submission can lead to fair compensation for your extra efforts.

An example of a 22 modifier would be a complex surgical procedure that takes significantly longer than a standard operation due to unforeseen complications or challenges. For instance, if a surgeon encounters extensive scar tissue during surgery, resulting in a longer procedure, they would utilize the modifier 22 on the claim. Including this modifier on your claim signals to payers that the service requires further explanation, which should be documented in the Modifier 22 Explanation Form. Understanding this example helps clarify when the modifier applies.

Documenting modifier 22 effectively requires thorough and precise record-keeping. It is essential to include detailed notes that describe the reasons for increased service complexity in your Modifier 22 Explanation Form. This documentation should capture the specifics of the procedure, patient conditions, and any challenges faced. Clear, well-organized documentation ensures that payers can evaluate your justification accurately and consider your request for additional reimbursement.

To justify modifier 22, healthcare providers need to clearly outline the reasons why the service rendered required additional effort or resources. It’s crucial to include specific details in your Modifier 22 Explanation Form that explains the complexity or intensity of the procedure. Providing comprehensive documentation, including surgery notes and patient circumstances, can strengthen your case for using this modifier. Ultimately, this justification helps payers understand the necessity for additional reimbursement.

BCBSND will reimburse procedure codes billed with the modifier 22 appended with a 20% increase to the physician fee schedule rate. Note: This is not applicable to services billed on the UB-04 Claim Form.

Modifier 22 is defined as "Increased Procedural Services: When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code.

Additional scenarios where modifier 22 could apply include maternity care involving cesarean delivery of multiple gestations, encountering exceptionally large tumors during a procedure or an event of excessive blood loss during surgery.

To use modifier 22 effectively, surgical documentation must include a description of: Why the care was especially difficult – the extenuating circumstances encountered intraoperatively that set this procedure apart from the standard expectation of complexity.

Modifier -22: Increased Procedural Services. This modifier is used to identify a service that requires significantly greater effort, such as increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required, than is usually needed for that procedure.