title: Asking for the 22-modifier in isolated ankle fractures: does the operative note make the case?
abstract: We evaluated the operative notes for justification on the use of the 22-modifier in ankle fracture cases and compared the differences in physician billing and reimbursement. A total of 265 patients who had undergone operative management of isolated ankle fractures across a 10-year period were identified at a level I trauma center through a retrospective chart review. Of the 265 patients, 61 (23.0%) had been billed with the 22-modifier. The radiographs were reviewed by 3 surgeons to determine the complexity of the case. The amount of the professional fees and payments was obtained from the financial services department. Operative reports were reviewed for inclusion of eight 22-modifier criteria and word count. Mann-Whitney U tests of means were used to compare cases with and without the 22-modifier. From our analysis of preoperative radiographs, 37 (60%) showed evidence of a significantly complex fracture that justified the use of the 22-modifier. A review of the operative reports showed that 42 (68%) did not identify 2 or more reasons for requesting the 22-modifier in the report. Overall, the 22-modifier cases were not always reimbursed significantly greater amounts than the nonmodifier cases. No significant difference in the average word count of the operative notes was found. We have concluded that orthopedic trauma surgeons do not appropriately justify the use of the 22-modifier within their operative report. Further education on modifiers and the use of the operative report as billing documentation is required to ensure surgeons are adequately reimbursed for difficult trauma cases.
authors.affiliation: Health Policy Fellow and Research Coordinator, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Rachel V
authors.initials: RV
authors.lastname: Thakore
authors.affiliation: Health Policy Fellow and Research Coordinator, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Greenberg
authors.affiliation: Medical Student, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Vasanth
authors.initials: V
authors.lastname: Sathiyakumar
authors.affiliation: Medical Student, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Prablek
authors.affiliation: Medical Student, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: David
authors.initials: D
authors.lastname: Elmashat
authors.affiliation: Medical Student, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Julian K
authors.initials: JK
authors.lastname: Hinson
authors.affiliation: Instructor of Orthopaedic Surgery and Rehabilitation, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: David
authors.initials: D
authors.lastname: Joyce
authors.affiliation: Professor of Orthopaedic Surgery and Rehabilitation, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
authors.affiliation: Assistant Professor of Orthopaedic Surgery and Rehabilitation, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN. Electronic address: Manish.Sethi@Vanderbilt.edu.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Sethi
mesh_terms: D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D039702:Current Procedural Terminology; D005260:Female; D005592:Fracture Fixation / Q000145:classification* / Q000191:economics; D006801:Humans; D007344:Insurance Claim Reporting; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011859:Radiography; D012051:Reimbursement Mechanisms / Q000191:economics*; D012189:Retrospective Studies; D014193:Trauma Centers
keywords: CPT code modifier; ankle fracture; reimbursement; surgery