Wiki What modifier??

[cvand1972]

Our local Medicare, NGS, is looking for a modifier on a hospital Consult and obviously they won't tell us so I've got to figure it out on my own.
Anyway, patient is seen for a Hospital Consult (99253) on 10/21. He then had a Cath by a different provider the same day (93510-26). He then had a pacemaker implant on 10/22 (33208) by the same provider that did the Consult on 10/21. What modifier do you think they are looking for on the Consult? I don't think it has anything to do with the Cath, but I could be wrong as we are new to these procedures.

 

[Jess1125]

I would say -57 since this is being done the day prior to the pacemaker insertion which has a 90 day global so long as this consult was the "decision for surgery".

 

[Cyndi113]

More than likely they are looking for -25 if the cath was done on the same day. Was the cath done by a provider from the same group. If so, definitely -25.

 

[cvand1972]

We had the same idea but we tried the 25 and they still denied it. Yes, it was done by a provider in the same group.

 

[Cyndi113]

That's weird. Then I agree with Mod -57.

 

[Mjones7]

I would bill the consult with a -57. I wonder, did the "diff provider" that performed the cath the same day as your consult billed a consult code in addition to the cath and now Medicare will not pay for your consult as the same svc is being billed on the same day?