Wiki Modifier 57 and a subsequent E/M

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rykin7609

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Every where I habe looked and everything I have read said to apply modifier 57 to appropriate E/M codes. I understand how they are used and for what reasons, what I need to know is can a modifier 57 be used on a subsequent hospital code? I cannot not find anything addressing this specific question.

I have a surgeon who performed a surgery, three days later the patient had to return to the OR for exploration which is a 90 day global. The surgeon saw this patient earlier that day for the second surgery and decided to take the patient back into the OR because of hemorrhaging, but all I have is the subsquent hospital visit. I want to bill for this service.

I previously billed 99232 with modifiers 25 and 24 thinking that I was unable to bill with a 57, and of course I am denied. Can anyone tell me or show me the reference that addresses this, as the term "appropriate" is actually very vague?
 
If the decision was made to perform the surgery during the subsequent visit then yes, you can use the 57 although documentation of the E/M should state decision was made to do another sx. Separate guidelines do not exist. You may want to use a 78 or 79 on the sx code for a return to the OR.

hope this helps
 
rykin7600 said:
Every where I habe looked and everything I have read said to apply modifier 57 to appropriate E/M codes. I understand how they are used and for what reasons, what I need to know is can a modifier 57 be used on a subsequent hospital code? I cannot not find anything addressing this specific question.

I have a surgeon who performed a surgery, three days later the patient had to return to the OR for exploration which is a 90 day global. The surgeon saw this patient earlier that day for the second surgery and decided to take the patient back into the OR because of hemorrhaging, but all I have is the subsquent hospital visit. I want to bill for this service.

I previously billed 99232 with modifiers 25 and 24 thinking that I was unable to bill with a 57, and of course I am denied. Can anyone tell me or show me the reference that addresses this, as the term "appropriate" is actually very vague?
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I am admittedly out of my specialty, though I have been coding for a long time. IMO you should not apply the modifer 57. This was apparently a complication of the first surgery. All appointments (scheduled or not) related to that surgery are included in the 90 day global period. You should bill for the 2nd surgery with a 78 modifier to show it was a complication of the first during the global period.

While I can't give you a reference other than the cpt book, I would say that unless you find a reference that says you can do something, you should not.

I could be wrong, perhaps some E&M folks will way in.

HTH :)
 
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