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Otolaryngology Coding Alert

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Can You Append Modifier 57 to 31231?

Published on Thu Feb 19, 2009

Question: My ENT wants to append modifier 57 on an E/M to decide to schedule sinus surgery. How is this modifier used and is it payable? For and E/M that resulted in 31231, could I append modifier 57 to 99213? Oklahoma Subscriber Answer: You-ll append modifier 25 to 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) because that code has zero global days. Use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) if the procedure being done is a minor procedure -- that is, it has zero to 10 global days per the Medicare Fee Database, and you are saying that the E/M is more than the small E/M associated with a minor procedure. Rather, it is a significant, separately identifiable E/M. That significant, separately identifiable E/M may ultimately be the decision to perform the [...]
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