Wiki Modifier -57 help

[johncyrose]

By definition, modifier -57 is to be added to E/M service that resulted in the initial decision to perform surgery. There are references online that say it is to be added to the E/M service provided one day before or the day of surgery, though. I used the definition on the CPT book when I appended -57 on the scenario I am describing below.

For an inpatient surgery admission on 01/03/2019 for acute gallstone pancreatitis, I assigned 99222 -57. The surgeon stated "possible OR this hospitalization for laparoscopic vs open cholecystectomy" in his plans.

The surgery did not happen until 01/05/2019. The surgeon saw the pt again on 01/04/19 and 01/05/19. To me those two days should be counted within the global period since these visits were only confirming the initial plan for surgery made on 01/03/2019. I am being asked at work to add the modifier -57 to the 01/05/19 visit, instead.

Any one who can shed some light on this dilemma? Thank you!

 

[jkyles]

Hi,

CPT Assistant, May 2009 states that the modifier may be used for E/M visits that result in the decision for surgery the day of or the day before a major procedure. ​

I'm assuming this is a major procedure so you're correct that day one of global period in your scenario would be Jan. 4. You wouldn't append a modifier to the visit on Jan. 3 because it is outside of the global period.

If the doctor

made the decision to perform surgery before Jan. 4, which seems to be the case here, you could not unbundle later visits with a modifier. ​

 

[johncyrose]

Hi,
CPT Assistant, May 2009 states that the modifier may be used for E/M visits that result in the decision for surgery the day of or the day before a major procedure.
I'm assuming this is a major procedure so you're correct that day one of global period in your scenario would be Jan. 4. You wouldn't append a modifier to the visit on Jan. 3 because it is outside of the global period.

If the doctor
made the decision to perform surgery before Jan. 4, which seems to be the case here, you could not unbundle later visits with a modifier.

Thank you so much for your reply.