Wiki 57 with E/M Services

[mscountry]

Hello: Please help if possible:

I have a physician that feels he can add the 57 modifier onto all his office visits.

Everything that I can find and read states. The original E/M visit must be with a fracture DX,IF there is an application of a cast or splint.
This will put the patient into a 90day global. You can only us the 57 modifier on the ORIGINAL visit.

We understand it is a decision of surgery. The fracture care is what is gray.

Thank you in advance for you help.

 

[dclark7]

When there is a decision for surgery you would use 57 on major procedures (90 day global) and 25 with minor procedures (0-10 day global) if the documentation supports the E/M. However billing for fracture care without manipulation may depend on the insurance carrier, some want 57 on the E/M and some want 25. Your best bet is to contact your insurance carriers and ask how they want these billed.

 

[mscountry]

EXAMPLE: Doctor is seeing a follow he wants to bill 99213 57 and 73020 xray rt shoulder. This is all he is doing. No manipulation, no cast, no splint.

I would understand if he was doing a splint, cast etc. Just wanting as much information to go to my doctors about.

 

[dclark7]

If all he's billing is an E/M and x-ray then no modifier is needed. Modifier 57 is only needed if an E/M with a decision for (major) surgery is made on the same day or the day before the surgery is done. If you have a CPT book, Appendix A gives the definitions for modifiers.

 

[mscountry]

--Thank you for the HELP..