Modifiers

Hopp

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Hi Just Wondering if anyone could help with the following:
My Doc admits a pt. 6/20 99223 for medical stabilization and further diagnostics, then on 6/21 does a sub.hosp visit 99232 with Decision for Sx 57 takes pt to OR for Lap Chole.
Medicare pays for the 6/21 visit but not the admit. I do know that there is a global but it doesnt make sense that he wouldnt get paid for the admit. Im still fairly new at all this anyway thanks for any help.
 

Lisa Bledsoe

True Blue
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They paid for 99232 on the day of surgery because the modifier is there... Global days start the day prior to surgery. When was the actual decision for surgery made? My "guess" is 6/20 when your doc admitted for medical stabilization, knowing surgery would be performed after the patient was stabilized. I don't think I would have reported the 99232-57 on 6/21; just the admit w/-57 on 6/20 and surgery 6/21. Then again, I don't know the full details.
 

Hopp

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Thank you for your response - Dec.for Sx was on 6/21 as on the day of admit he was also doing diagnostic testing so he didn't decide until the next day. So I didn't think that was right they would pay for a sub.visit but not the admit.
 
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