PDF(Pubmed)
Abstract：
UNASSIGNED: Modifier 22 is a mechanism designed for surgeons to identify cases that are more complex than their Current Procedural Terminology code accounts for. However, empirical studies of the use and efficacy of modifier 22 are lacking.
UNASSIGNED: To assess the use of modifier 22 in common surgical procedures and the association of use with compensation.
UNASSIGNED: This was a cross-sectional analysis of the 2021 Physician/Supplier Procedure Summary Limited Data Set including all Part B carrier and durable medical equipment fee-for-service claims. Claims for 10 common surgical procedures were evaluated, including mastectomy, total hip arthroplasty, total knee arthroplasty, coronary artery bypass grafting, laparoscopic right colectomy, laparoscopic appendectomy, laparoscopic cholecystectomy, kidney transplant, laparoscopic total abdominal hysterectomy and bilateral salpingo-oophorectomy, and lumbar laminectomy. Data were analyzed from August to November 2023.
UNASSIGNED: Rate of modifier 22 use, rate of claim denial, mean charges, mean payment for accepted claims, and mean payment for all claims.
UNASSIGNED: The sample included 625 316 surgical procedures performed in calendar year 2021. The proportion of modifier 22 coding for a procedure ranged from 5725 of 251 521 (2.3%) in total knee arthroplasty to 1566 of 18 459 (8.5%) in laparoscopic total abdominal hysterectomy and bilateral salpingo-oophorectomy. Submitted charges were 11.1% (95% CI, 9.1-13.2) to 22.8% (95% CI, 21.3-24.3) higher for claims with modifier 22, depending on the procedure. Among accepted claims, those with modifier 22 had increased payments ranging from 0.8% (95% CI, 0.7-1.0) to 4.8% (95% CI, 4.5-5.1). However, claims with modifier 22 were more likely to be denied (7.4% vs 4.0%; P < .001). As a result, overall mean payments were mixed, with 4 procedures having lower payments when modifier 22 was appended, 4 procedures having higher payments with modifier 22, and 2 procedures with no difference. The largest increase in mean payment for modifier 22 claims was for kidney transplant with an increased payment of $71.46 (95% CI, 55.32-87.60), which translates to a relative increase of 3.4% (95% CI, 2.9-4.6).
UNASSIGNED: The findings in this study suggest that modifier 22 had little to no financial benefit when appended to claims for a diverse panel of surgical procedures. In the current system, surgeons have little reason to request modifier 22, and no mechanisms currently exist for surgeons to recoup payment for difficult operations.
UNASSIGNED: To assess the use of modifier 22 in common surgical procedures and the association of use with compensation.
UNASSIGNED: This was a cross-sectional analysis of the 2021 Physician/Supplier Procedure Summary Limited Data Set including all Part B carrier and durable medical equipment fee-for-service claims. Claims for 10 common surgical procedures were evaluated, including mastectomy, total hip arthroplasty, total knee arthroplasty, coronary artery bypass grafting, laparoscopic right colectomy, laparoscopic appendectomy, laparoscopic cholecystectomy, kidney transplant, laparoscopic total abdominal hysterectomy and bilateral salpingo-oophorectomy, and lumbar laminectomy. Data were analyzed from August to November 2023.
UNASSIGNED: Rate of modifier 22 use, rate of claim denial, mean charges, mean payment for accepted claims, and mean payment for all claims.
UNASSIGNED: The sample included 625 316 surgical procedures performed in calendar year 2021. The proportion of modifier 22 coding for a procedure ranged from 5725 of 251 521 (2.3%) in total knee arthroplasty to 1566 of 18 459 (8.5%) in laparoscopic total abdominal hysterectomy and bilateral salpingo-oophorectomy. Submitted charges were 11.1% (95% CI, 9.1-13.2) to 22.8% (95% CI, 21.3-24.3) higher for claims with modifier 22, depending on the procedure. Among accepted claims, those with modifier 22 had increased payments ranging from 0.8% (95% CI, 0.7-1.0) to 4.8% (95% CI, 4.5-5.1). However, claims with modifier 22 were more likely to be denied (7.4% vs 4.0%; P < .001). As a result, overall mean payments were mixed, with 4 procedures having lower payments when modifier 22 was appended, 4 procedures having higher payments with modifier 22, and 2 procedures with no difference. The largest increase in mean payment for modifier 22 claims was for kidney transplant with an increased payment of $71.46 (95% CI, 55.32-87.60), which translates to a relative increase of 3.4% (95% CI, 2.9-4.6).
UNASSIGNED: The findings in this study suggest that modifier 22 had little to no financial benefit when appended to claims for a diverse panel of surgical procedures. In the current system, surgeons have little reason to request modifier 22, and no mechanisms currently exist for surgeons to recoup payment for difficult operations.
摘要：
■修改器22是为外科医生设计的一种机制，用于识别比他们的当前程序术语代码所占的更复杂的病例。然而,缺乏对改性剂22的使用和功效的实证研究。
■评估改性剂22在普通外科手术中的使用以及使用与补偿的关联。
这是对2021年医师/供应商程序摘要有限数据集的横截面分析，包括所有B部分运营商和耐用医疗设备按服务收费索赔。评估了10种常见外科手术的索赔，包括乳房切除术,全髋关节置换术,全膝关节置换术,冠状动脉旁路移植术,腹腔镜右结肠切除术,腹腔镜阑尾切除术,腹腔镜胆囊切除术,肾移植,腹腔镜全腹子宫切除术和双侧附件卵巢切除术，和腰椎椎板切除术.数据从2023年8月至11月进行了分析。
■改性剂22的使用率，索赔拒绝率，平均收费，表示已接受索赔的付款，意味着所有索赔的付款。
■样本包括2021日历年进行的625316次外科手术。编码手术的修饰符22的比例从全膝关节置换术中的251521中的5725（2.3％）到腹腔镜全腹子宫切除术和双侧附件卵巢切除术中的18459中的1566（8.5％）。提交的费用为11.1%（95%CI，9.1-13.2）至22.8%（95%CI，21.3-24.3），取决于程序。在接受的索赔中，修改量为22的患者的支付量从0.8%(95%CI,0.7-1.0)增加到4.8%(95%CI,4.5-5.1).然而,修改项22的索赔更有可能被拒绝（7.4%vs4.0%；P<.001）。因此,总体平均支付情况参差不齐，当附加修饰符22时，4个程序的支付较低，用修改器22支付较高的4个程序，和没有区别的2个程序。修改22项索赔的平均付款增加最大的是肾脏移植，增加了71.46美元（95％CI，55.32-87.60），这意味着相对增加了3.4%(95%CI，2.9-4.6)。
本研究中的发现表明,当附在一组不同的外科手术程序的权利要求中时,改性剂22几乎没有经济益处。在当前系统中,外科医生几乎没有理由要求修饰符22，目前还没有任何机制可以让外科医生收回困难手术的费用。
■评估改性剂22在普通外科手术中的使用以及使用与补偿的关联。
这是对2021年医师/供应商程序摘要有限数据集的横截面分析，包括所有B部分运营商和耐用医疗设备按服务收费索赔。评估了10种常见外科手术的索赔，包括乳房切除术,全髋关节置换术,全膝关节置换术,冠状动脉旁路移植术,腹腔镜右结肠切除术,腹腔镜阑尾切除术,腹腔镜胆囊切除术,肾移植,腹腔镜全腹子宫切除术和双侧附件卵巢切除术，和腰椎椎板切除术.数据从2023年8月至11月进行了分析。
■改性剂22的使用率，索赔拒绝率，平均收费，表示已接受索赔的付款，意味着所有索赔的付款。
■样本包括2021日历年进行的625316次外科手术。编码手术的修饰符22的比例从全膝关节置换术中的251521中的5725（2.3％）到腹腔镜全腹子宫切除术和双侧附件卵巢切除术中的18459中的1566（8.5％）。提交的费用为11.1%（95%CI，9.1-13.2）至22.8%（95%CI，21.3-24.3），取决于程序。在接受的索赔中，修改量为22的患者的支付量从0.8%(95%CI,0.7-1.0)增加到4.8%(95%CI,4.5-5.1).然而,修改项22的索赔更有可能被拒绝（7.4%vs4.0%；P<.001）。因此,总体平均支付情况参差不齐，当附加修饰符22时，4个程序的支付较低，用修改器22支付较高的4个程序，和没有区别的2个程序。修改22项索赔的平均付款增加最大的是肾脏移植，增加了71.46美元（95％CI，55.32-87.60），这意味着相对增加了3.4%(95%CI，2.9-4.6)。
本研究中的发现表明,当附在一组不同的外科手术程序的权利要求中时,改性剂22几乎没有经济益处。在当前系统中,外科医生几乎没有理由要求修饰符22，目前还没有任何机制可以让外科医生收回困难手术的费用。
