Modifier 22
The 22 modifier is used to identify an unusual procedural service. By using this modifier you are indicating that the procedure in question required a level of care greater than that usually required. When using this modifier medical records must be submitted with the claim to support the increased level of care and allow for possible additional payment. The documentation for the 22 modifier should include statements specific to the added time spent, or the complicating factors that added to the difficulty of the procedure. The operative note alone often provides no such details on the added time. If records are not submitted with the claim the procedure will pay based on the standard fee schedule amount.
Modifier 24 for E&M Services During the Global Period of a Surgical Procedure
The -24 modifier is used to report unrelated Evaluation and Management (E&M) services performed during the postoperative, global period by surgeon. This applies to providers of all specialties who perform
surgical procedures.
The Medicare Carriers Manual section 4822 A (7) advises physicians that services submitted with the ” -24″ modifier must be sufficiently documented to establish that the visit was unrelated to the surgery. An ICD-9-CM code that clearly indicates that the reason for the encounter was unrelat ed to the surgery is acceptable documentation.
“Routine check -ups, ” ordered for following a chronic condition which may be related to the surgery disease, like glaucoma, are not separately paid during the global period. If the patient has a chronic condition, such as glaucoma, the documentation must clearly show a suspected change or acute incident in order for the E&M service to be considered unrelated to routine postoperative care. For example, a diagnosis of diabetes mellitus does not clearly support the encounter is unrelated to cataract extraction. However, an E&M service for a diabetic patient with visual changes and suspected retinal detachment would be covered during the global period with the -24 modifier.
