Wiki modifier 57

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Caseym517

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I have a question regarding the use of a modifier 57.

Scenario:
Patient is admitted as an inpatient to the hospital on March 1st. Cardiothoracic surgery is called for a consult because patient has a pneumothorax. Chest tube is placed by cardiothoracic surgery on March 1st after initial visit on March 1st. Cardiothoracic surgery service continues follow up care each day. The surgeon see's the patient on March 10th and explains to the patient that he will need surgery if the chest x-ray does not show any change the following morning. The patient did not agree to go forward with surgery at that time on March 10th. The patient wanted to wait until the next morning to make a decision for surgery. Patient is seen the following morning, March 11th and the chest x-ray did not change. The surgeon and the patient both decide to go forward with surgery on March 11th. Can a modifier 57 be appended to the E & M code billed on March 11th which is the same day as the surgery. Surgery is performed on March 11th and was billed using CPT 32655.

Please advise.

Thank you.
 
What Insurance does the patient have?

Medicaid of Al does not allow 57 mod.

Medicaid does not allow E&M on a major day of sugery.

BCBS does not allow to bill a subsequent visit to be billed with CPT 32655(Check BCBS website)

If insurance is Medicare or United health care you can bill with a 57 mod.

This is more insurance specific.

Hope this helps.







Caseym517 said:
I have a question regarding the use of a modifier 57.

Scenario:
Patient is admitted as an inpatient to the hospital on March 1st. Cardiothoracic surgery is called for a consult because patient has a pneumothorax. Chest tube is placed by cardiothoracic surgery on March 1st after initial visit on March 1st. Cardiothoracic surgery service continues follow up care each day. The surgeon see's the patient on March 10th and explains to the patient that he will need surgery if the chest x-ray does not show any change the following morning. The patient did not agree to go forward with surgery at that time on March 10th. The patient wanted to wait until the next morning to make a decision for surgery. Patient is seen the following morning, March 11th and the chest x-ray did not change. The surgeon and the patient both decide to go forward with surgery on March 11th. Can a modifier 57 be appended to the E & M code billed on March 11th which is the same day as the surgery. Surgery is performed on March 11th and was billed using CPT 32655.

Please advise.

Thank you.
Click to expand...
 
kalpana said:
Medicaid of Al does not allow 57 mod.

Medicaid does not allow E&M on a major day of sugery.

BCBS does not allow to bill a subsequent visit to be billed with CPT 32655(Check BCBS website)

If insurance is Medicare or United health care you can bill with a 57 mod.

This is more insurance specific.

Hope this helps.
Click to expand...

Ok, Can a modifier 57 be billed with the E & M code on the same day of surgery since the decision for surgery was made at that time even though we have been seeing the patient throughout this inpatient stay?

Thank you.
 
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