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

Modifier 22 is a billing modifier that may provide additional reimbursement and can be used for complex operative procedures requiring greater surgeon time or effort. However, Modifier 22 utilization has been infrequently analyzed in the upper extremity. Our purpose was to assess patient, injury, and surgeon characteristics associated with Modifier 22 utilization associated with operative treatment of distal radius fractures (DRFs).

A retrospective chart review of operatively treated adult DRFs between 2016 and 2020 was conducted within a single, integrated health care system. We recorded patient, surgeon, and injury characteristics as well as the utilization of a Modifier 22 code. A binary multiple logistic regression model was constructed from patient, injury and surgeon demographic factors. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were reported.

Twenty-one surgeons performed 934 included DRF cases, of which 101 cases (11%) used a Modifier 22 code. Modifier 22 utilization ranged from 0% to 38% by surgeon. Hand fellowship training was significantly associated with increased Modifier 22 utilization (OR 3.53, 95% CI [1.95-6.38]). Significantly increased Modifier 22 utilization was also associated with government/military insurance compared to private insurance (OR 9.63, 95% CI [1.89-49.12]), open fractures (OR 4.94, 95% CI [1.42-17.24]), and increased operative time (OR 1.05, 95% CI [1.03-1.08]). "Increased service intensity or procedural time" and "increased technical difficulty" were the most commonly cited coding justifications.

For DRF, Modifier 22 utilization varies widely by the surgeon. Hand fellowship training, insurance status, and open fractures were significantly associated with increased utilization. Fracture classification (exclusive of open fractures) and body mass index were not associated with higher rates of Modifier 22 utilization.

These data suggest that utilization of Modifier 22 codes associated with DRF is primarily driven by surgeon-specific billing practices, training and case length rather than complex fracture patterns and obesity.