Wiki 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!
 
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.
 
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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