Modifier 22 fact sheet
First Coast identified claims reporting modifier 22 (increased procedural services) without supporting documentation. To avoid claim rejects and future appeals due to incorrect claim submissions, we’re providing guidance on how to properly submit a claim when applying modifier 22.
Effective August 31, 2023, documentation will be required to process claims submitted with modifier 22. Medical review will no longer send an additional documentation request (ADR) for these claims. Claims with modifier 22 should be submitted with required supporting documentation following the PWK process outlined below. Claims not containing supporting documentation will be rejected.
Modifier 22
Under certain circumstances, it may be necessary to indicate that a procedure or service is significantly greater than usually required.
Appropriate usage
You may report modifier 22 when work to provide a service is substantially greater than typically required. Documentation must support the substantial additional work and the reason for the additional work such as:
- Increased intensity
- Time
- Technical difficulty of procedure
- Severity of patient’s condition
- Physical and mental effort required
Inappropriate usage
- Do not append modifier 22 to an E/M (Evaluation & Management) service.
- Only report it with procedure codes that have a global period of 0, 10, or 90 days.
- Only report it with procedure codes that have a global period of 0, 10, or 90 days.
How to submit supporting documentation
Your documentation should provide our reviewers with a clinical picture of the patient; the procedures or services performed and support the use of modifier 22. Depending on the documentation, we may or may not allow additional reimbursement.
First Coast requires a copy of the operative and/or progress reports as supporting documentation for claims billed with modifier 22.
Note: This information cannot be provided in the narrative field on the claim.
Please see below for details on providing documentation:
- Medical review will no longer send an ADR for these claims. Claims with modifier 22 should be submitted with required documentation following the PWK process.
- PWK is a process that allows you to submit documentation with an initial claim. Learn more here.