Modifier 22 Use in Surgical Treatment of Distal Radius Fractures Within an Integrated Health Care System

Area of Science:

• Orthopedic surgery
• Health economics
• Medical billing and coding

Background:

• Modifier 22 is used for complex procedures requiring additional surgeon time or effort.
• Analysis of Modifier 22 utilization in upper extremity surgery, specifically distal radius fractures (DRFs), is limited.
• Understanding factors influencing Modifier 22 use is crucial for accurate reimbursement and resource allocation.

Purpose of the Study:

• To investigate patient, injury, and surgeon characteristics associated with Modifier 22 utilization in operatively treated DRFs.
• To identify predictors of Modifier 22 code application in this patient population.
• To provide insights into the variability of Modifier 22 use among surgeons.

Main Methods:

• Retrospective review of adult DRF cases treated operatively between 2016 and 2020.
• Data collection included patient demographics, injury details, surgeon characteristics, and Modifier 22 code usage.
• Binary multiple logistic regression analysis was performed to identify significant factors associated with Modifier 22 utilization.

Main Results:

• Modifier 22 was utilized in 11% of 934 DRF cases, with surgeon-specific rates ranging from 0% to 38%.
• Hand fellowship training (OR 3.53), government/military insurance (OR 9.63), open fractures (OR 4.94), and increased operative time (OR 1.05) were significantly associated with higher Modifier 22 use.
• Common justifications included "increased service intensity/procedural time" and "increased technical difficulty".

Conclusions:

• Modifier 22 utilization for DRFs is highly variable and influenced by surgeon training, insurance type, and fracture severity (open vs. closed).
• Factors such as fracture classification (excluding open fractures) and body mass index did not correlate with increased Modifier 22 use.
• Surgeon billing practices, training, and case length appear to be primary drivers of Modifier 22 use, rather than solely fracture complexity or patient obesity.