Wiki Modifier 57 99223 w/36800 Hospital Consults

[ldonaldson]

Hi

I know that rules have changed for billing hospital consults with procedures. Also, I have not had a lot of experience with billing hospital consults = can you added modifier 57 to 99223 and bill 36800 (insertion of cannulation) consult same day or day before procedure 36800. (BCN)

All help appreciated.
Lynda

 

[thomas7331]

The rules for the use of the modifiers on E&M codes are no different for hospital locations than for any other place of service - I'm not sure what changes you're referring to. In any case, ,modifier 57 is only for applicable for E&M codes with major procedures that have a 90-day global period, which does not apply to 36800, so that would not be correct here. If the documentation of the consultation service does support a separately identifiable E&M service on the same date, then 25 would be appropriate. If the consultation took place the day before the procedure, then no modifier is necessary.