• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

E/M with a decision for 90days global surgery. July 2023 Magazine.

N

natashalage

Expert
Messages
390
Location
Lincoln, CA
Hello Coders! :)
I need your help please. Could you please tell me why we couldn't code E/M with a modifier 57 (decision for surgery 90days global)? In this case, it's a New pt, MD evaluated the pt's condition and made a decision for surgery. I understand that 90day global package includes 1day before surgery (pre-op e/m) but in this case, MD sees the pt for the first time and that's when the treatment plan is established.
Thank you very much for your rational!
1688928172685.png
 
I agree with you. The evaluation to make the decision for surgery is not part of the global package of a major procedure. Since it occurred during the global period, billing it with the modifier 57 is appropriate. The rationale they’re giving you is incorrect, unless something has just recently changed that I’m not aware of.
 
Is there something changing for FY 2024 perhaps? I don't code surgeries, so I haven't been paying attention to anything regarding upcoming changes. I just noticed that the dates in the question are specifically 10/1/2023 and 10/2/2023. Of course, the dates could be just a coincidence too.

The answers for the quiz can usually be easily referenced in the corresponding issue of Healthcare Business Monthly, but I don't have it open right now.
 
Hi there, I spend more time reading CMS rules and AMA guidelines than I care to admit. I've seen nothing (current or pending) about a change to modifier 57. In addition, such a change would have every surgical society in an absolute uproar. Again, I haven't heard a peep.

Also, as someone who has to write CEU quizzes - no one is perfect. 😖
 
jkyles said:
Hi there, I spend more time reading CMS rules and AMA guidelines than I care to admit. I've seen nothing (current or pending) about a change to modifier 57. In addition, such a change would have every surgical society in an absolute uproar. Again, I haven't heard a peep.

Also, as someone who has to write CEU quizzes - no one is perfect. 😖
Click to expand...

That makes sense. Upcoming surgical changes aren't something I've been keeping an eye out for, because for the past year I've been exclusively coding radiation oncology.

The 10/1 date caught my eye as a possibility, but it does appear that it was just an error after all.
 
You must log in or register to reply here.
Top