Wiki Modifier 57 - decision for surgery

[abazcoder]

My question is on correct use of 57 modifier for inpatient hospital visits
Example:

a patient slips, falls and is admitted to the hospital and is then seen by a doctor for an inpatient exam.
Then the following day the patient is taken into surgery
Can you bill for the exam the previous day with a 57 modifier (decision for surgery)?

I work in the billing office of a large orthopaedic practice, and I see this charge come through once in awhile, however I find that most of the time the insurance denies the visit as part of global package.

So does the global package rule of 1 e/m service day before or day of surgery take presedence over a -57 modifier?
Would the doctor's report showing he made a decision for surgery just the day before help at all?

thanks for any suggestions!

 

[JWINGES]

I use this all the time in the ortho practice that I am in and I always get the E&M visit paid for the day before surgery. Give it a shot the worst thing that happens is they deny it the other side of the coin your docs will be happy when they see that it is paid.

 

[Treetoad]

If this is your orthopedist's initial decision for surgery, then you are entitled to charge for the service with modifier 57, as long as your documentation reflects this.