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Hello,
I am trying to determine if it is acceptable to use a 57 modifier on the E/M code used for an exam if we already have the surgery scheduled with the surgery center.
I have two different scenarios.
1- Our doctor saw the patient 6 months ago and noticed they had a secondary cataract developing. We scheduled them to come back in 6 months for an evaluation of this and go ahead and added them to the surgery schedule for a YAG (CPT-66821).
2- A referring optometrist refers a patient for secondary cataract symptoms. We schedule them for an eval and also add them to the surgery schedule for a YAG (CPT-66821).
Would it be appropriate to use Modifier 57 since they are already "scheduled" for surgery on the surgery center schedule?
Per WPS, the definition of 57 Modifier:
Definition:
I am trying to determine if it is acceptable to use a 57 modifier on the E/M code used for an exam if we already have the surgery scheduled with the surgery center.
I have two different scenarios.
1- Our doctor saw the patient 6 months ago and noticed they had a secondary cataract developing. We scheduled them to come back in 6 months for an evaluation of this and go ahead and added them to the surgery schedule for a YAG (CPT-66821).
2- A referring optometrist refers a patient for secondary cataract symptoms. We schedule them for an eval and also add them to the surgery schedule for a YAG (CPT-66821).
Would it be appropriate to use Modifier 57 since they are already "scheduled" for surgery on the surgery center schedule?
Per WPS, the definition of 57 Modifier:
Definition:
- Indicates an Evaluation and Management (E/M) service resulted in the initial decision to perform surgery either:
- The day before a major surgery (90 day global), or
- The day of a major surgery