General Question for the Week of May 11, 2020

Question:

My doctor wants me to add modifier 22 to the code for the procedure he performed. I don’t see anything in the report that indicates the case was more difficult. What does the doctor need to document to justify the use of modifier 22?

Answer:

CPT® code valuation is an average of the work normally required for a code. Sometimes the work required will be less, sometimes more. Only when the work required is substantially more than normal is modifier 22 assigned. Documentation should indicate what additional work was done and why it was necessary. According to the CPT description for modifier 22, this might be increased intensity, time, technical difficulty of the procedure, the severity of the patient’s condition, or physical and mental effort required. Payers may request documentation to support the additional payment allowed by modifier 22, so it should be available in the medical record, and ideally in the dictated report.