Wiki E/M w/ 57 modifier and operative report denial

[dkknight]

We have seen an influx of denials from payer sources (VA, BCBS and work comp) denying the E/M with a 57 modifier because the E/M and operative services weren't billed on same claim.

Is anyone else seeing this?

Thank you.

Deb Knight, CPC, COC
Missoula Bone & Joint & Surgery Center

 

[hopepg]

I haven't noticed this denial...yet!

Is the place of service different for each code?
Example,
Provider sees patient in hospital & a decision for surgery is made for same day. E/M code & procedure have same POS so can be billed on same claim.
or
Provider sees patient in clinic & a decision for surgery is made for later in day at facility. E/M code billed with clinic POS & procedure billed with facility POS on separate claims.