Modifier 57

fishbite2

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Phoenix, AZ
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Can modifier 57 be used on an exam by a physician within the same practice if he did not perform the surgery? First Dr performed the exam and referred to a surgeon within the same practice who did surgery the same day. The surgeon did not bill an exam. Thanks
 

Mikiu2000

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Who made the decision that the patient needed surgery and advised patient on benifits, risks and alternatives and patient agreed.
 

fishbite2

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The office notes for Dr #1 states "refer to retina dr for laser prophylaxis today." The notes for Dr #2 shows that he obtained consent and performed the laser.
 
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Milwaukee WI
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Same specialty & same practice

Two physicians of the same specialty in the same practice are - for billing purposes - considered the same physician.

I would use a -57 modifier on the office visit if that is when the decision was made that surgery is required.

We have this happen with our surgeons - Surgeon A sees a patient in clinic and determines patient needs surgery; on-call surgeon B is able to fit patient in today. We put a -57 on Surgeon A's office visit charge.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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