- Hospital ASC and Outpatient Coders
- Do not bombard the Medicare contractor or other third-party payer with unnecessary documentation. All attachments to the claim for justification of the unusual services
justification of unusual services should be easy to locate within the attached documentation. Highlight this information, if necessary, to facilitate the medical reviewer’s access to the pertinent supporting data.
Key points :
Claims submitted to Medicare, Medicaid, and other third-party payers containing modifier 22 for
unusual procedural services that do not have attached supporting documentation that illustrates the unusual distinction of the services will generally be processed as if the procedure codes were not appended with this modifier. Some third-party payers might suspend the claims and request additional information from the provider, but this is the exception rather than the rule.