Otolaryngology Coding Alert

Between the decision and the surgical procedure, 24-hours is key. You could improve payment for preparotid and polyp removal service if you know when to append modifier 57. Hint: To ensure payment for the hospital E/M prior to a same-day decision for surgery, you must use modifier 57 (Decision for surgery). Here are some guidelines to follow with this procedure: Reserve 57 for Major Surgeries You should only modifier 57 report 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 the date or date before the surgery 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 and Children's University Medical Group Compliance Program. Example: [...]