rhaney1033
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How do I do this? New inpt initial hospital care (99221) with the decision for both procedures (19303, 90 day global) & (36561, 10 day global). Medicare patient. I used the 57 modifier on the 99221. Medicare denied 99221 so we appealed.
This is the response from Medicare: We received an unfavorable appeal response letter from Medicare dated 12/31/2015. The letter states that although the request included supporting documentation, the modifier that describes this instance was not included. The 57 modifier was reported but this modifier is not the appropriate modifier for the situation that applies because there is both a major and minor surgery on the date in question. Please review for an appropriate modifier.
Help! Confused...
This is the response from Medicare: We received an unfavorable appeal response letter from Medicare dated 12/31/2015. The letter states that although the request included supporting documentation, the modifier that describes this instance was not included. The 57 modifier was reported but this modifier is not the appropriate modifier for the situation that applies because there is both a major and minor surgery on the date in question. Please review for an appropriate modifier.
Help! Confused...