Modifier 22

Modifier 22 – Increased Procedural Services

Modifier 22 is appended with listed procedure codes, when the effort required to provide a service is significantly greater than typically required. Modifier 22 should be appended only when the medical records or office notes support the significant additional effort and the reason for the additional effort.

Important Note: Modifier 22 should not be appended with E/M service codes.

Usage of modifier 22 along with examples:

1. Abortion:

Usually second trimester is from 14 weeks 0 days to less than 28 weeks 0 days.

While doing the abortion if the fetus age is greater than 20 weeks, then we can report the claim with modifier 22 to indicate increased procedural services.

Because physician will have much complication and takes more time to do abortion, if the fetus age is greater than 20 weeks when compared to the fetus age which is less than 20 weeks. So to indicate the increased of work for performing the abortion of fetus age greater than 20 weeks, we use modifier 22.

Example:

Physician performs induced abortion of the fetus aged 21 weeks, by dilation and evacuation.

We should report the claim with procedure code 59841 along with modifier 22.

Procedure code 59841 can be reported with modifier 22 to indicate increased procedural services performed by physician.

• Maternity Care and Delivery:

Examples:

Below three Scenarios includes routine obstetric care including antepartum and postpartum care.

Scenario 1:

If its twin baby and the procedure is normal vaginal delivery, then we report the code as follows 59400, 59409 with modifier 51.

Procedure code 59400, 59409 reported with modifier 51.

Scenario 2:

If its twin baby, first baby is conducted normal vaginal delivery and second baby is delivered by cesarean section, then we report the code as follows 59510, 59409 with modifier 51

CPT Code 59510, 59409 appended with modifier 51.

Scenario 3:

If its twin baby and both the babies delivered by cesarean section. Since it’s a twin baby, we should report the code as follows 59510 along with modifier 22 to indicate increased procedural services performed.

Procedure code 59510 appended with modifier 22.

• Delivery(Vaginal/Cesarean) after previous cesarean delivery (VBAC):

For vaginal delivery after previous cesarean delivery, we report the claim with appropriate procedure code from 59610 to 59614.

For cesarean delivery after previous cesarean delivery, we report the claim with appropriate procedure code from 59618 to 59622.

Examples:

Scenario 1:

Patient was already delivered a baby by cesarean section two years back. Now the patient comes for twin baby delivery. First baby conducted normal delivery and second baby is delivered by cesarean section, then we report the procedure code 59618, 59612 with modifier 51.

59618, 59612 with modifier 51

Scenario 2:

Patient was already delivered a baby by cesarean section two years back. Now the patient comes for twin baby delivery, both the babies delivered by cesarean section. Here we report the procedure code 59618, since it’s a twin baby we report with modifier 22 to indicate increased procedural service.

59618 with modifier 22.