AAPC: Append Modifier 22 to Unusually Difficult Procedures

An AAPC report discusses the correct use of modifier 22 Increased procedural services to increase reimbursement for an especially difficult or time-consuming procedure.

Written by Sarah Reed, CPC, and G. John Verhovshek, MA, CPC, the article discusses the effort required to get modifier 22 claims paid when documenting and submitting the claim. As explained in CPT Appendix A, modifier 22 indicates the work performed during a procedure was "substantially greater than typically required," according to the report. The guidelines do not specify a definition for "substantially greater" effort, so the AAPC report recommends coders follow specific payor requirements.

For example, some payors require the work be at least 25 percent greater than usual. Ms. Reed and Mr. Verhovshek said coders should append modifier 22 infrequently, for only the most difficult procedures, regardless of payor.

Read the AAPC report on appending modifier 22.

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