Each procedure code is expected to have a certain degree of length, risk, and complexity. When the service offered is more complicated, complex, difficult or takes significantly longer than usual, add modifier 22 to the procedure code
• When the use of modifier 22 is permissible, an additional fee may be permitted.
• Other payment concerns may not apply to every paid code. Once the paperwork submitted states the exceptional nature of service provided, will extra reimbursement be regarded.
• Modifier 22 always necessitates a code review.
• Modifier 22 should not be appended to unlisted codes.

When Modifier 22 is applicable

Validity necessitates the presence of two or more of the following points, or the company of one

of the following factors that can contribute to extended anesthesia:

Being overweight is so severe that it complicates the surgical procedure.

Difficulties during surgery due to co-morbidities.

Trauma is severe enough to aggravate the procedure but not billed as an extra procedure code.

Other pathologies, tumors, and malformations (genetic, traumatic, or surgical) that directly interact with the process but are not individually billed.

The services provided are far more complicated than those described for the CPT code in question.

Difficult surgical procedure.

Modifications or removals of previous operative work that are uncommonly complex and hard.

Other valid uses for modifier 22

Other valid uses of modifier 22 may also be specified in different scenarios. For example, if the leading operative site is challenging and time-consuming, additional compensation for the primary procedure may be justified.

However, supplementary procedures performed through the same incision may not meet the exact requirements.

Discounts for multiple procedures will continue to apply.

This procedure does not exempt claims from clinical code edits related to additional services and other code edits.

Incorrect Modifier Usage

Adding this modifier to a code without explaining a rare event in a medical record. Many payers do not recognize it due to its overuse.

Relying on this modifier regularly. That would undoubtedly raise a red flag about the claim and result in an audit.

Utilizing modifier 22 to imply a specialist performed a procedure. Modifier 22 should not be used for specialty designation.

Coding Procedures

Modifier -22 signifies a facility that needed significantly more effort than regular and started falling well outside the normal range. According to the AMA, when using the modifier -22 on an insurance claim, the operative report should be sent along with the claim to indicate and explain the unusual facility. The medical record documentary evidence must support both the significant additional work and the purpose for the extra efforts (e.g., increased intensity, time, technical difficulty of the procedure, patient’s condition intensity, physical and mental effort required).