ImportanceModifier 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.ObjectiveTo assess the use of modifier 22 in common surgical procedures and the association of use with compensation.Design, Setting, and ParticipantsThis 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.Main Outcomes and MeasuresRate of modifier 22 use, rate of claim denial, mean charges, mean payment for accepted claims, and mean payment for all claims.ResultsThe 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).Conclusions and RelevanceThe 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.

中文翻译：

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修饰符 22 在按服务付费医疗保险中的使用

ImportanceModifier 22 是一种为外科医生设计的机制，用于识别比他们的手术更复杂的病例当前的程序术语代码占.然而，缺乏对修饰剂 22 的使用和功效的实证研究。目的评估修饰剂 22 在常见外科手术中的使用以及使用与补偿的关联。设计、设置和参与者这是对 2021 年医师的横断面分析/供应商程序摘要有限数据集，包括所有 B 部分承运人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、冠状动脉搭桥术、腹腔镜右半结肠切除术、腹腔镜阑尾切除术、腹腔镜胆囊切除术、肾移植、腹腔镜全腹部子宫切除术和双侧输卵管卵巢切除术以及腰椎切除术。椎板切除术。数据分析时间为 2023 年 8 月至 11 月。主要结果和措施修饰符 22 使用率、索赔拒绝率、平均费用、已接受索赔的平均付款以及所有索赔的平均付款。结果样本包括日历年进行的 625 316 例外科手术2021 年，修饰符 22 编码的手术比例范围为全膝关节置换术中的 251 521 例中的 5725 例（2.3%）到腹腔镜全腹部子宫切除术和双侧输卵管卵巢切除术中的 18 459 例中的 1566 例（8.5%）。对于修饰符为 22 的索赔，提交的费用要高出 11.1%（95% CI，9.1-13.2）至 22.8%（95% CI，21.3-24.3），具体取决于程序。在已接受的索赔中，修饰符为 22 的索赔金额增加了 0.8%（95% CI，0.7-1.0）至 4.8%（95% CI，4.5-5.1）。然而，修饰符为 22 的索赔被拒绝的可能性更大（7.4% vs 4.0%；磷< .001）。结果，总体平均付款是混合的，其中 4 个程序在附加修饰符 22 时具有较低的付款，4 个程序在附加修饰符 22 时具有较高的付款，2 个程序没有差异。修饰符 22 索赔的平均付款增幅最大的是肾移植，付款额增加了 71.46 美元（95% CI，55.32-87.60），相对增加了 3.4%（95% CI，2.9-4.6）。 结论相关性本研究的结果表明，当附加到多种外科手术的索赔中时，修饰符 22 几乎没有任何经济利益。在当前系统中，外科医生几乎没有理由请求修改器22，并且当前不存在外科医生收回困难手术费用的机制。