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Is 57 Modifier Appropriate for this?

abazcoder

Networker
Messages
29
Location
Tucson, AZ
Best answers
0
Hi all,
I work in Orthopaedics and have a question on the use of 57 modifier

We had a patient who was admitted to the hospital (after going through the ER)
Our doc went and provided an inpatient consult at the requst of the hospitalist for the patient (who had slipped, fallen & fractured her leg)

Our doctor completed the consult and said "surgery"....
however, the patient was not medically cleared for another 5 days (due to irregular blood tests that came back initially).
but 5 days later the surgery was performed.

Our charges for this inpatient consult were denied as "global"---
which I understand given the guidelines for pre-op visits in the global package...
However, this exam happened 5 days before the surgery,,,,not the day before or day of the surgery...
could I not append a 57 mod and send the corrected claim back with doctor's notes showing that was when the decision for surgery was made?

Thank you all :)

Thank you
 
Messages
8
Location
Jersey City, NJ
Best answers
0
I would not only use the 57 modifier and send the notes as to when the surgical decision was made, but I would also send the notes as to why the surgrey was postponed.
 

abazcoder

Networker
Messages
29
Location
Tucson, AZ
Best answers
0
Hi Myra,
Thanks for your help.....that's pretty much what I thought,
but I usually like to bounce my ideas off another coder just so I know I'm on the right track!

Thanks again,
Amy
 
Messages
4,466
Location
Milwaukee WI
Best answers
0
You shouldn't need 57

You really shouldn't need the 57 modifier at all, as the visit was clearly outside the global period.

I would appeal with the consult notes and the date of surgery clearly outlined and let the carrier know that this was obviously outside the global period.

(But if adding the 57 is what it takes for the carrier to pay, then go for it.)

F Tessa Bartels, CPC, CPC-E/M
 
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