A specialist is preparing a claim for a procedure with a prolonged operative time that has modifier -22. What action should the specialist take?

Submitting a claim with modifier -22, which indicates a procedure that required significantly more work than typical, necessitates additional documentation to justify the use of this modifier. In this case, including a copy of the operative report with the claim is the appropriate action to take. The operative report contains crucial details about the procedure, such as the complexity, time taken, and any complications that may have arisen. This information provides supporting evidence to the payer, helping to establish the medical necessity for additional reimbursement due to the prolonged operative time.

Without this documentation, the claim may be denied or the payer might not understand the rationale behind using modifier -22, since modifiers are intended to clarify certain situations in billing. Therefore, providing the operative report directly aligns with the expectations of insurance companies when they review claims involving modifiers for additional work.