Orthopedic Coding Alert

Question: You said (February 1999 issue, page 14) to add modifier -57 to code 99221 in admitting a patient from the emergency room when the patient had surgery two days later. However, a patient seen in the ER and admitted two days before surgery should not need the modifier -57, as the CPT manual states the code is for use in a global period. Two days before surgery is not within the global period for surgery; that period starts 24 hours before surgery.

The Paducah (KY) Orthepaedic Clinic

Answer: Technically, since you are outside the global period, modifier -57 should not be necessary. If it is truly the date of decision for surgery, placing the modifier on the admission codeeven if it is outside the global periodshould not cause a problem. (Some carriers, such as Blue Cross/Blue Shield, that require documentation when using this modifier, may object. Often surgery is planned for the day of admission or the next day, but then it is postponed. Or, surgery is planned for several days ahead but is performed sooner. In this case, you would need the modifier -57 since the E/M service is now within the global period. Therefore, it may be easier to use the modifier on the day of the decision for surgery, even if the E/M service falls outside of the global period.

Remember, you can easily miss the service date if a good system isnt in place for capturing the information from your physician. Its easier to train your physicians to always give you certain pieces of information than to expect them to remember when a coding item can or cant be used. The billing staff then can edit the information based on the carriers requirements.