-25-57 or just -57

mbort

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Ortho surgeon sees patient in consult as inpatient, does an aspiration for suspected sepsis. Later in the evening the results come back and he takes the patient to the OR for an I & D for infection.

I know I am thinking about this wayyyy too hard.

99252-25-57 or just 99252-57??
23031-RT
20610-RT

Looking for insight from others
Thanks
Mary
 

mbort

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Thanks Lisa---I didnt even check the global days on the 23031!! duh..Thanks!!!

what if it were a 90 global on the major surgery? What would you use?? (for future brain warps)
 
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Hi,

I think I would use both....the modifier that corresponds to each of the procedure codes billed.

Just my two cents....Good Luck!
 

dmaec

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I've never used an RT/LT on the 20610. Is that needed on this code? I have used .50 when done bilaterally - but (and I can't recall who said or the reasoning behind it), I've not used the RT/LT.

oh, I found my "reasoning" - apparently, it isn't need on this code - but the RT/LT will be used as informational..
 
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gina_marie

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So, this is along the same lines but what if a patient comes in for fracture care? The fracture care has a -90 day global (ex: 28475) so a -57 modifier would be appropriate, however I am being told that you also need to add a -25 modifier due to the fracture care being a "procedure" done on the same day.

They have:
99243 -25/-57
28475
Can someone please help? I have been told 2 different things now and am thoroughly confused!!!
 
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-25 OR -57 not both

Gina-Marie,
You use a -57 modifier on the E/M to show that it is the "decision for surgery" for a major procedure performed the same or next day of service. (Major procedure defined as having 90-day global period; fracture care is a major procedure)

You use a -25 modifier to identify a significant, separate E/M from a MINOR procedure done the same date (minor is defined as having 0-10 day global period).

You do not need to have both, UNLESS you have a carrier that has specified that how they want it listed.

However, many carriers will still deny the E/M and you have to appeal. And in my experience, Medicaid (Title 19) never pays for the E/M on the same date as procedure.

F Tessa Bartels, CPC, CPC-E/M
 
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