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Decision for surgery

  1. Default Decision for surgery
    Medical Coding Books
    I have provider who is reporting an e&m service (99220) the day prior to AND the day of a major surgery. The provider is appending the e&m code the day of surgery (99232) with mod 57. Is this correct? The observation visit record states "will observe for now, but if not better in the a.m., will consider surgery" The next day, the provider performs an appendectomy. Should both services be allowed? If not, which service should have the -57 modifier?

  2. Default
    Appending modifier 57 to 99220 would be advisable because 99220 carries 2.99 work RVUs and 99232 carries 1.39 work RVUs. Payor will deny one E/M as preop e/m w/o modifier 57. So, its better to get paid for 99220 rather than 99232.

  3. #3
    i dont think i would bill the 99232 on day of surgery. it just doesnt seem necessary to me, especially if the surgery was his "next step" in the treatment plan that he outlined on the day he admitted to OBV. Also, i'm not sure of the cpt code for an appendectomy but dont forget to verify that the procedure carries a 90 day global since you are using modifier -57. Otherwise, you would use a -25.
    hope that helps!
    Dawnelle Beall, CPC, CPMA, CPC-I
    Licensed AAPC PMCC Instructor
    AAPC ICD-10CM Certified Trainer
    Previous AAPC Local Chapter President & VP

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