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We have a patient that had a toe fx charge back in December; he's still under that global period. Came in yesterday with a new wrist fx. Do I put both 24 & 57 on the E/M??
was the wrist surgery on the same/next day, and is it a 90 day global? -57 only applies when the procedure is major surgery, and when it is scheduled for the same or next day.
Assuming you will be treating the wrist fracture this same DOS, then Yes, you would append both the -24 and -57 modifier to show that this E/M service was
1) UNrelated to earlier surgery/fracture care, though provided during the global period of that earlier procedure
-and-
2) the Decision for Surgery for new procedure/fracture care.
I agree, that if fracture care is being done for the wrist, you would add both the -24 and -57 modifiers. Both are needed to tell the whole story for this visit.