tswitzer
New
I have a letter that we received for a RAC audit on a couple of claims from one of our general surgeons. The provider saw the patient as an inpatient and it was decided that we needed to perform an EGD on one and an I & D on another. The E & M was appended with a 57 modifier. The letter states that the E & M is not payable with a 57 modifier when the procedure has a 0 or 10 day global period. Both procedures have a 0 day global which to me means that NOTHING else is included in the CPT for the procedure. I found some samples that talk about a 25 modifier. I see noting in the description saying it included an E & M so I an wondering if the real issue is it should have had a modifier not a 57. Both times the patient was taken to a procedure room, it was not done in the hospital room. I felt like it was billed correctly but I am confused now.