Modifier 22 —Is It All Just a Catch-22?

The study by Childers et al provides insights into the flaws of fee-for-service payment systems when it comes to the surgical care of complex patients. The study found that the magnitude of additional payments associated with the use of modifier 22 was small, and this was almost completely offset by increased claim denials. These results are sure to be disappointing to surgeons who frequently use modifier 22 believing that it will lead to additional compensation related to the time and stress associated with more challenging cases. The findings highlight the ongoing challenge with reliably rewarding health care professionals for delivering appropriate, high-quality care to more complex patients. While models have been proposed and even tested, most have failed because it is difficult to objectively measure surgical complexity and risk.
Source: JAMA Surgery - Category: Sports Medicine Source Type: research