Results 1 to 3 of 3

Use of 57 modifier

  1. #1
    St. Louis, Missouri
    Default Use of 57 modifier
    Medical Coding Books
    I just wanted to throw this out there to see if anyone has been told this before. Someone at Aetna told our A/R person that we need to append a modifier 57 on an initial consultation if it is done up to 10 days prior to a major (90 day global) surgery. Example: We do an initial consultation on 9/23/09 and decide that surgery is necessary and so we schedule the surgery. The surgery is scheduled for 9/30/09. The surgery is performed on 9/30/09. They are saying that we should append a modifier 57 on the consultation code from 9/23/09. I have never heard of this before. It has always been my understanding that the 90 day global only includes 1 day prior to the surgery. Has anyone else ever heard of this 10 days prior?

    Melissa Blow, CPC

  2. #2
    No I haven't but Aenta has a lot of very strict and specific rules. I would ask them for their policy on this in writing. If they say the global period starts 10 days prior to surgery it should be documented and they should be able to provide you with that.

    Good luck,

    Laura, CPC, CEMC

  3. #3
    Columbia, MO
    Laura is correct, different payers, and even some states have state statutes on this, can designate what the preop timeframe is.. I have experienced this many times for 10 days or 7 days and even up to 14 days prior to the surgery.

    Debra A. Mitchell, MSPH, CPC-H

Similar Threads

  1. Replies: 2
    Last Post: 09-18-2015, 01:17 PM
  2. Modifier 59 vs Modifier 91 for Laboratory
    By leahrey in forum Modifiers
    Replies: 1
    Last Post: 06-23-2015, 12:01 PM
  3. MODIFIER PT VS MODIFIER 33 Screening Colonoscopy
    By Ann Johnson in forum Modifiers
    Replies: 2
    Last Post: 07-19-2012, 07:08 AM
  4. Modifier 58 versus Modifier 78
    By Ramona03 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-04-2012, 12:10 PM
  5. Modifier 51 Versus Modifier 59
    By Sborkowski in forum Modifiers
    Replies: 3
    Last Post: 05-26-2009, 03:59 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.