Cardiology Coding Alert

Question: "Check Major Vs. Minor for Mod 57," in Cardiology Coding Alert, Vol. 12, No. 13, described appending modifier 57 to an inpatient consult code. Now that Medicare doesn't accept consult codes, how should we report the case?

South Carolina Subscriber

Answer: The short answer is that, for that case, you should append modifier 57 (Decision for surgery) to the non-consult inpatient E/M code that the documentation supports.

The case you reference involved a 2009 level-three inpatient consult in which the cardiologist determined the patient required an inferior vena cava (IVC) filter placed later the same day. Adding the modifier to the E/M code helps show payers why you're reporting an E/M in addition to the major surgery performed later that day, represented by 37620 (Interruption, partial or complete, of inferior vena cava by suture, ligation, plication, clip, extravascular, intravascular [umbrella device]).

The exact E/M code you choose will depend on the circumstances specific to the visit, such as whether the visit is the cardiologist's first or second visit during the admission. As an example, suppose you're coding the cardiologist's first visit to an inpatient. Your documentation may support 99221 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity ...), which has requirements similar to level-three inpatient consult code 99253 (Inpatient consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity...).

You should append modifier 57 to the E/M code. If the cardiologist is the principal physician -- the one overseeing the patient's care -- be sure to append modifier AI (Principal physician of record), as well.