• 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 your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We're introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

E/M with closed fracture treatment

dovejsd

Networker
Messages
40
Best answers
0
I have NO ortho experience so I am appealing to you ortho coders:

When billing for fracture care in the office one of our ortho providers bills an E/M with modifier 57 and then the code for the fracture care. (ex: 99213-57 and 27530) Our billing system does not like the modifier 57 and wants a modifier 25 used. The provider is insisting that since the fracture care has a 90 day global period that modifier 57 should be used. I need to know which modifier is correct, and where I can find the documentation to support the answer.

Thanks so much!
 

JenLawson

Networker
Messages
52
Best answers
0
Modifier 57 indicates that a decision for surgery was made. If this is the case then 57 is a correct modifier. If not then 25 would likely be the modifier to use.

In the CPT book there is a quick reference for the modifiers inside the front cover, if you want the full description you need to look in appendix A near the back of the book.
 

scooter1

Expert
Messages
396
Best answers
0
per Supercoder.com

General Surgery Coding Alert
Modifier -57 Gains Payment for Preoperative Exams


Medicare guidelines stipulate that evaluation and management services provided the day before or the day of a major surgery (i.e., a surgery with a 90-day global period) are included in the surgery's global package and are not separately reimbursable. If the preoperative exam prompted the decision for surgery, however, separate reimbursement is warranted and may be achieved if the visit is properly documented and modifier -57 (Decision for surgery) has been appended
 

primrose1

Guru
Messages
115
Best answers
0
Your provider is correct. If a procedure has a 90-day f/u period, modifier 57 is added to the E/M code, as is in this case with a fracture. If a cast is applied during the initial visit, you also bill for the supplies. Subsequent cast changes during the global period, bill for the cast application and supplies along with any x-rays done.

If a procedure is considered "minor", 10-day global period or less (i.e., injection), modifier 25 is added to the E/M {If a patient is scheduled to come in for a planned injection, i.e. viscosupplement, then only the injection/medication codes are billed - no E/M}.


Kris, COSC
 
Top