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Modifier 57 - decision for surgery

  1. #1
    Default Modifier 57 - decision for surgery
    Medical Coding Books
    My question is on correct use of 57 modifier for inpatient hospital visits

    a patient slips, falls and is admitted to the hospital and is then seen by a doctor for an inpatient exam.
    Then the following day the patient is taken into surgery
    Can you bill for the exam the previous day with a 57 modifier (decision for surgery)?

    I work in the billing office of a large orthopaedic practice, and I see this charge come through once in awhile, however I find that most of the time the insurance denies the visit as part of global package.

    So does the global package rule of 1 e/m service day before or day of surgery take presedence over a -57 modifier?
    Would the doctor's report showing he made a decision for surgery just the day before help at all?

    thanks for any suggestions!

  2. #2
    I use this all the time in the ortho practice that I am in and I always get the E&M visit paid for the day before surgery. Give it a shot the worst thing that happens is they deny it the other side of the coin your docs will be happy when they see that it is paid.

  3. Default
    If this is your orthopedist's initial decision for surgery, then you are entitled to charge for the service with modifier 57, as long as your documentation reflects this.


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