Wiki Mod 50 with fx care

[apollo06]

sorry the title should say MODIFIER 57 with fx care

I dont understand the adding of modifier 57 when provider performs closed NON manipulated fx care (i.e 22310)-where a brace and rest if given for treatment

I understand the definition of mod 57, however I dont understand how it relates to fx care in some cases. Is it because fx care is considered "surgery" by CMS and have global periods?
thank you

 

[mitchellde]

you apply the 57 modifier to the E&M when the documentation supports that the provider did not know the extent of the injury and had to examine the patient beyond the necessity to perform the fx care. In other words it is the same parameters of the 25 modifier. without the 57 modifier the E&M will bundle to the fx care. If the provider knew the limb was fracture and that fx care would be provider prior to assessing the patient then there can be no E&M charged. Some payers prefer the 25 when the fx care is administered in the office setting and some stick with the post op day rule of if the post op days are greater than 10 you use the 57.
Alos fx care is considered surgical due to being in the surgical range of codes. this is not a CMS definition, all codes 10000-69999 are surgical procedures by AMA definition.

 

[apollo06]

Thank you that helps to understand it better.