Modifier 57 - variety of payers

lengyelm

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Hello,

I am seeing a lot of denials by a variety of payers for the E/M code with 57 modifier when a surgery is done the same day or day after.
Is anyone else seeing this? We have been appealing with no success. I am not sure what the increase is caused by but we are following CMS guidelines with the use of this modifier.
Any suggestions?

Thank you!
 

hopepg

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Others might have other opinions to your question.... Here's mine:
I use a double modifier 25 57 when an E/M is billed (& supported by documentation) on the same DOS as the surgery. If I have billed that way & still get a denial, I go through the reconsiderations/appeal steps for the particular insurance.
 

CodingKing

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Some insurance carriers don't pay for E&M on same day or day before a minor procedure even if its decision for surgery. What kind of responses are you getting from the appeals? do they point to a policy or reason they wont consider the charge?
 
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