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What modifier??

  1. Default What modifier??
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    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.

  2. #2
    Default
    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".

  3. #3
    Location
    Phoenix, AZ
    Posts
    620
    Default
    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.
    Last edited by Cyndi113; 11-13-2009 at 02:17 PM.
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  4. Default
    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.

  5. #5
    Location
    Phoenix, AZ
    Posts
    620
    Default
    That's weird. Then I agree with Mod -57.
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  6. #6
    Default
    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?
    Mjones7

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