When submitting an electronic claim for a procedure with modifier -22, what action should the billing and coding specialist take?

Including an attachment to the claim when submitting an electronic claim with modifier -22 is essential for providing additional documentation that supports the necessity of the modifier. Modifier -22 is used to indicate that the service provided was increased or complex, often resulting in additional work beyond what is typically expected for the procedure.

When a billing and coding specialist submits a claim with this modifier, it is crucial to provide the insurance company with adequate justification for the increased complexity or effort involved. Attachments may include operative reports or detailed explanations of the circumstances that warranted the use of modifier -22. This thorough documentation can enhance the likelihood of a successful claim approval and ensure that the provider is reimbursed appropriately for the additional services rendered.

Submitting without attachments may lead to denials or requests for additional information, which can delay payment. Verifying with the insurance provider or switching to paper claims are not the most efficient or effective routes when the necessary documentation is already present and can be submitted electronically.