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  #1  
Old 09-19-2011, 07:42 AM
nancy.anselmo@ccrheart.com nancy.anselmo@ccrheart.com is offline
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Talking Modifier 57 vs Modifier 25

I am still confussed about when to use modifier 57. Pt presented to hospital. Dr did a consult on him as he had unstable angina and CAD. During this encounter the decision was made to do a LHC. Do I use the 25 or the 57 on the 99214 pt was in observation. Thanks Nancy
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Old 09-19-2011, 08:48 AM
abbyfraise abbyfraise is offline
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If the surgery was the same day you would use the 25
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Old 09-19-2011, 09:43 AM
banderson77 banderson77 is offline
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depends on the post op period for the procedure. If the procedure has a 90 day global period then the office visit/consult gets a 57. All other produres (10 day or less global period) the office visit gets a 25.
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Old 09-19-2011, 10:16 AM
mad49erdog mad49erdog is offline
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Default mod 57 use w/major surgery decision

An E&M service provided the day before or the day of a major surgery that resulted in the initial decision to perform surgery is eligible for reimbursement if modifier -57 is appended to the E&M code.
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Old 09-19-2011, 04:03 PM
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Cyndi113 Cyndi113 is offline
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It is definitely dependent on the post op days (minor vs major). However, there is no post op period for a heart cath. So in answer to your question, use a -25.

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Old 09-19-2011, 04:05 PM
kbarron kbarron is offline
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Why aren't you using the observation codes in the observation setting?
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Old 09-19-2011, 06:04 PM
Mojo Mojo is offline
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Quote:
Originally Posted by kbarron View Post
Why aren't you using the observation codes in the observation setting?
Since the OP's physician was a consulting provider, it appears he did not initiate the observation status and he would use office or other outpatient codes.
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Old 09-24-2011, 07:52 PM
tlspeer tlspeer is offline
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I really found the information useful. I did not know that global period had anything to do with whether a modifier-25 or -57 was used.
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Old 10-03-2011, 08:54 AM
SMITTY1959 SMITTY1959 is offline
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Its a good idea to check with your payor as well. LHC's are considered diagnostic where we are and are not a surgical code so we use mod 25 on the E/M.
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Old 10-04-2011, 10:02 AM
hayleeh hayleeh is offline
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Default Mod 25 or 57 for er e/m codes

I have a plastic surgeon/er doc who uses e/m codes 99281-99285, he does his own coding and we audit. We're all confused which modifier to use? 25 or 57? For ex a pt came to an er with a 1.3 cm laceration of the right nostril, so the doc coded 99284 57 for the visit and 12051 for the repair. Do I change the mod 57 to 25 since it's just stitches and not a surgery? Does mod 25 need two diagnosis codes? Help!
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