Richman James H, Mears Simon C, Ain Michael C
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Orthopedics. 2012 Aug 1;35(8):e1256-9. doi: 10.3928/01477447-20120725-29.
The 22 modifier is a Current Procedural Terminology code modifier that allows surgeons to receive additional reimbursement for complex procedures. The goal of this study was to evaluate the rate of, time to, and factors affecting reimbursement for 22-modifier cases filed by orthopedic surgeons. The authors reviewed the charts and billing data of the 150 noncharity spine and total joint replacement cases filed with a 22 modifier at 1 academic institution from 2004 through 2011. Of those 150 cases, 63 (42%) were reimbursed at a rate higher than the fee schedule. For all 150 cases, the mean amount and mean percentage of additional reimbursement were -$86±$1966 (P=.7) and 5.5%±37% (P=.04), respectively. The mean reimbursement time for private and public payers was 138±126 days (P<.001) and 118±129 days (P<.001), respectively (standard time, 30 and 15 days, respectively). The mean present values of the amount and percentage received compared with the fee schedule were -$144±$1966 (P=.8) and 4.1%±37% (P=.09), respectively (discount rate, 5%). Anatomic variant was the only cited reason that increased the probability of additional reimbursement (P=.016). Citing that the case required additional time had no bearing on additional reimbursement. The authors conclude that additional reimbursement with the 22 modifier is inconsistent, has significant payment delays, and is not worth the effort for total joint replacement or spine surgery.
22 修改码是一种现行程序术语编码修改码，它允许外科医生在进行复杂手术时获得额外补偿。本研究的目的是评估骨科医生提交的使用 22 修改码病例的补偿率、补偿时间以及影响补偿的因素。作者回顾了 2004 年至 2011 年期间在 1 家学术机构提交的 150 例非慈善脊柱和全关节置换病例的病历及计费数据。在这 150 例病例中，63 例（42%）获得了高于收费标准的补偿。对于所有 150 例病例，额外补偿的平均金额和平均百分比分别为 -86±1966 美元（P = 0.7）和 5.5%±37%（P = 0.04）。私人支付方和公共支付方的平均补偿时间分别为 138±126 天（P < 0.001）和 118±129 天（P < 0.001）（标准时间分别为 30 天和 15 天）。与收费标准相比，获得的金额和百分比的平均现值分别为 -144±1966 美元（P = 0.8）和 4.1%±37%（P = 0.09）（贴现率为 5%）。解剖变异是唯一被提及的增加额外补偿可能性的原因（P = 0.016）。声称病例需要额外时间与额外补偿无关。作者得出结论，使用 22 修改码的额外补偿不一致，存在显著的支付延迟，对于全关节置换或脊柱手术来说不值得付出努力。
