Results 1 to 3 of 3

Admit and Modifier 57

  1. #1
    Default Admit and Modifier 57
    Exam Training Packages
    Need opinion:

    Patient tranferred from rural hospital to urban hospital, diagnosis obstructive hydrocephalus, Patient in semi-coma state. Surgeon is there waiting for patient, admits upon arrival and does a ventricular drain placement.

    Doc billed the admit (99223)with modifier 57 and the procedure. Insurance denies saying admit is part of global. They pay the procedure.

    Is the admit payable?

    Thanks for the input.

  2. #2
    Default
    I agree that the admit is global. If the -57 was to be used, wouldn't it have been for during the visit in the rural hospital since that is where the decision was made to transfer the patient to do the surgery? I only ask, because I am not totally sure either, but is makes more sense, I think, don't you?

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default Would need to see documentation to be sure
    I would need to see the actual documentation to be sure, but in most cases the initial hospital visit WOULD be billable with the -57 modifier.

    The patient may have been seen at another hospital but THIS surgeon hadn't seen the patient to make the final decision to perform surgery until the patient arrived at THIS hospital.

    The reason I say that I would need to see the documentation ,however, is that you state the patient was semi-comatose on arrival. This makes me wonder whether there was sufficient documentation for the 99223.

    If you have adequate documentation, I would appeal citing the "decision for surgery" rules.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

Similar Threads

  1. In-Patient Admit w/25 Modifier
    By BGoldsberry in forum Modifiers
    Replies: 0
    Last Post: 10-25-2012, 10:01 AM
  2. Modifier 25 and admit codes?
    By 634sg4fs65g4fg in forum Cardiology
    Replies: 3
    Last Post: 08-18-2010, 10:52 AM
  3. ER and then admit
    By willette in forum E/M
    Replies: 2
    Last Post: 08-17-2009, 01:09 PM
  4. Re-admit
    By Gemini18 in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 06-19-2009, 07:42 PM
  5. admit discharge then admit to snu
    By cooper1 in forum E/M
    Replies: 1
    Last Post: 04-01-2009, 11:20 AM

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?

Login

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.