RTW Modifier 22 FactsheetModifier 22 is used when the factors influencing how complicated a procedure was, are documented in detail. It is important to make sure this modifier is appropriately reported and that you have a thorough understanding of modifier 22 to ensure you’re getting the additional revenues you qualify for. Continue reading below for more information about modifier 22.

Are you protecting the additional revenue you deserve for increased services by appending modifier 22 appropriately? Modifier 22 is appropriate when the provider’s documentation precisely describes what made the procedure more complicated.

In order to assure this modifier is appropriately reported, it is important to have a good understanding of the full code descriptor according to CPT:

“When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (i.e., increased intensity, time, technical difficulty of procedure, severity of a patient’s condition, physical and mental effort required). Note: This modifier should not be appended to an E/M service.”

In order to ensure appropriate use of modifier 22, it is recommended to:

  1. Understand the full description of the modifier.
  2. Include details about time involved.
  3. Explain what activities extended the length of procedure.
  4. Document all conditions that required care and impacted/increased the difficulty of the procedure.
  5. Paint a clear picture of the complexity/activities involved for said procedure. 6. Be familiar with individual payment policies and reimbursement impact. Payers update these details often.

The following example displays additional documentation (outside of a well-detailed procedure note) that supports appropriate use of modifier –22:

Additional Details of Procedure:
The hysterectomy procedure took an extended amount of time of 3 hours due to the large size of the uterus with multiple bulky fibroids making visualization and instrumentation difficult. The morcellation took at least 2 hours to complete due to the large size of the uterus and multiple calcified fibroids.