Otolaryngology Coding Alert

Watch out: Some payers may direct you to use this modifier instead.In these tough economic times, every dollar counts--and if you're not applying modifier 57 (Decision for surgery) when your ENT performs a hospital E/M prior to the decision for surgery, you could be leaving ethical reimbursement on the table. Reserve 57 for Major SurgeriesYou should only report modifier 57 when the otolaryngologist decides to treat a condition surgically on the day before or the day of a 90-day global period procedure per Medicare guidelines. "The documentation must support that the decision for surgery was made on that date and it was not a scheduled surgery," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle. Example: An otolaryngologist admits a patient with parotitis to the hospital for IV antibiotics. Three days later, the patient develops [...]