More on modifier 22 from Medicare carrier WPS

by: CHARLES FIEGL Jun 9, 2009

The carrier WPS produced a fact sheet on modifier 22 (increased procedural services) June 8. We wrote about the modifier this week, noting denial rates for claims with the modifier have crept upward from 2005-2007. More than one in every four of these claims are denied by Medicare.

Here are some tips from the WPS fact sheet on appropriate usage:

Surgeries where services performed are significantly greater than usual.
Anatomical variants could be an appropriate use of the modifier.
Assistant at surgery claims where a procedure is significantly greater than usual.
Procedures having a global surgery indicator of 000, 010, or 090 on the Medicare Physician Fee Schedule Database (MPFSDB).
Procedures having a global period but not surgical services (i.e. 77761, 77777, 77782).

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