TianaElyse
Contributor
Hi all, I’m looking for clarification and peer insight on the appropriate use of Modifier 57 in dermatology, specifically in the context of Mohs surgery followed by adjacent tissue transfer (flap repair).
Scenario:
A patient is scheduled for Mohs surgery in advance, based on biopsy and pathology review. On the day of surgery, the Mohs procedure is performed first. After clear margins are achieved, the provider evaluates the defect and discusses repair options with the patient. A flap repair (a major procedure with a 90-day global period) is then performed. The provider wants to bill an E/M with Modifier 57 on the basis that the decision to perform the major procedure (flap) was made after the Mohs and before the flap, in a sterile but pre-incision environment.
The provider’s stance is that this is not intraoperative, and that the Modifier 57 is appropriate because the major procedure decision was made at that point.
My understanding, based on CMS’s Global Surgery Booklet, Medicare Claims Processing Manual, excerpts from ACMS “Ask Glenn”, and definition of modifier -57, is that the decision for Mohs constitutes the primary surgical decision, and any closure that follows (even if complex) is part of the intraoperative workflow and therefore not eligible for a separate E/M.
I’d love to hear how others approach this and if there are local LCD's or payer-specific carve-outs, that would be helpful to know as well.
Thank you in advance!
Scenario:
A patient is scheduled for Mohs surgery in advance, based on biopsy and pathology review. On the day of surgery, the Mohs procedure is performed first. After clear margins are achieved, the provider evaluates the defect and discusses repair options with the patient. A flap repair (a major procedure with a 90-day global period) is then performed. The provider wants to bill an E/M with Modifier 57 on the basis that the decision to perform the major procedure (flap) was made after the Mohs and before the flap, in a sterile but pre-incision environment.
The provider’s stance is that this is not intraoperative, and that the Modifier 57 is appropriate because the major procedure decision was made at that point.
My understanding, based on CMS’s Global Surgery Booklet, Medicare Claims Processing Manual, excerpts from ACMS “Ask Glenn”, and definition of modifier -57, is that the decision for Mohs constitutes the primary surgical decision, and any closure that follows (even if complex) is part of the intraoperative workflow and therefore not eligible for a separate E/M.
I’d love to hear how others approach this and if there are local LCD's or payer-specific carve-outs, that would be helpful to know as well.
Thank you in advance!