MEZIESKY
Guru
When doing an office visit and casting 26720 same day do you use modifier 57 or 25
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Wiki casting and E/M same day... 57 or 25
- Thread starter MEZIESKY
- Start date
amyjph
True Blue
Read up on the description of Modifier 57 and Modifier 25.
Then look up the CPT 26720. That is not a cast application CPT. Then you can look up the global days for the CPT in question by using a look-up tool such as this: https://www.palmettogba.com/palmetto/fees_front.nsf/fee_main?OpenForm
Once you know the global days, you can determine which modifier is appropriate.
You also have to consider if the documentation supports a separate E/M with the procedure on the same date.
References: https://www.cms.gov/files/document/mln907166-global-surgery-booklet.pdf
www.novitas-solutions.com
www.novitas-solutions.com
Then look up the CPT 26720. That is not a cast application CPT. Then you can look up the global days for the CPT in question by using a look-up tool such as this: https://www.palmettogba.com/palmetto/fees_front.nsf/fee_main?OpenForm
Once you know the global days, you can determine which modifier is appropriate.
You also have to consider if the documentation supports a separate E/M with the procedure on the same date.
References: https://www.cms.gov/files/document/mln907166-global-surgery-booklet.pdf
Modifier 25 fact sheet
www.novitas-solutions.com
Modifier 57 Fact Sheet
www.novitas-solutions.com
NRaizman
Expert
Amy is entirely correct.
Is this the definitive treatment of the fracture? If so, you can code 26720, with the first cast included in the 90-day global.
If the documentation supports a separate E&M, you would use a -57 modifier so that it does not get kicked out.
In general, if your provider only sees a patient once or twice in the global period, using a fracture management code -may- make more money than inidividual E&Ms, but patients often get upset when they get a EOB suggesting a "procedure" was done and a charge for $1000, and the headaches of explaining how a global period works may not be worth the overall reimbursement. We also have ER docs throwing a splint on and charging a fracture code with absolutely zero intent of seeing the patient during the global, in which case, the use of 54/55 modifier is mandated by CMS but use is spotty in real life.
N.
Is this the definitive treatment of the fracture? If so, you can code 26720, with the first cast included in the 90-day global.
If the documentation supports a separate E&M, you would use a -57 modifier so that it does not get kicked out.
In general, if your provider only sees a patient once or twice in the global period, using a fracture management code -may- make more money than inidividual E&Ms, but patients often get upset when they get a EOB suggesting a "procedure" was done and a charge for $1000, and the headaches of explaining how a global period works may not be worth the overall reimbursement. We also have ER docs throwing a splint on and charging a fracture code with absolutely zero intent of seeing the patient during the global, in which case, the use of 54/55 modifier is mandated by CMS but use is spotty in real life.
N.