Medical Practice Management
May 28

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 Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →