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Modifier 22 Increased Procedural Services Modifier 22 may be reported when the procedural work exceeds the typical effort required for 20610, such as when significant joint edema, severe synovitis, or complex fluid aspiration requires prolonged or technically difficult manipulation

Reference: Small molecule inhibitor of nicotinamide N-methyltransferase shows anti-proliferative activity in HeLa cells (2021)

Studies show its mostly well tolerated, with the most common side effects being flu-like symptoms and fatigue