Practice Management Alert
Modifier -57 and Minor Procedures Dont Mix
Question: We use modifier -57 on separately identifiable E/M services during which the decision for surgery is made, either on the day before or the day of a surgical procedure. We make sure the service warrants a separate charge, but we still get denied for the claims. Do you have any clue as to what we're doing wrong? California Subscriber Answer: If you're tacking modifier -57 (Decision for surgery) on minor surgical services, that's probably why you're seeing denials for these charges. You Be the Expert and Reader Questions provided by Mary Dykstra, RT, CPC, billing manager at Medical Center of Stafford in the Roanoke, Va., area; Judith Richardson, RN, MSA, CCS-P, a senior consultant with Hill & Associates; reviewed by Catherine Brink CMM, CPC, president of Healthcare Resource Management Inc., in Spring Lake, N.J.
Modifier -57 is used for separately identifiable E/M services rendered the day before or day of a major surgical package. Modifier -57 tells the payer, "We know that this preoperative visit is part of the surgical package, but the physician needed a separate, identifiable E/M in order to reach the decision to perform surgery." Usually services requiring that type of E/M visit have 90-day global packages. Minor services do not require that type of E/M visit from a physician. If your physician does a consultation the day before or the day of surgery, and the physician decides that the patient needs surgery, you should put modifier -57 on your consultation codes.
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Modifier -57 and Minor Procedures Dont Mix
Question: We use modifier -57 on separately identifiable E/M services during which the decision for [...]
