Modifier 57 and a subsequent E/M

rykin7609

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Local Chapter Officer
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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?
 

magmae

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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
 

dpeoples

True Blue
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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?

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 :)
 

rykin7609

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Local Chapter Officer
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modifier 57

Thank you, yes, both replies did help quite a bit.
 
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