Modifier 22 reminder – Support the ‘Increased’ Argument

CPT designed modifiers to represent the extra physician work involved in performing a procedure because of extenuating circumstances present in a patient encounter. Modifier 22 represents those extenuating circumstances that don’t merit using an additional or alternative CPT code, but instead raise the reimbursement for a given procedure. The key to collecting reimbursement for increased procedures is all in the documentation. Sometimes a physician will tell you he did “x, y and z,” but when you look in the documentation, the support isn’t there. Documentation is your chance to demonstrate the special circumstance that warrants modifier 22.

Also, don’t forget to add on the additional dollar amount that you are asking for by using the modifier. Payers just don’t pay you extra with this modifier; you need to say I am asking for $____ extra and this is why.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.