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modifier 57

  1. #1
    Default modifier 57
    Medical Coding Books
    Question: An MD consults on a patient in the hospital early in the week and indicates the plan is for the patient to have surgery later in the week with a partner. The NP for the same group rounds on the patient for the rest of the days prior to surgery checking neuro status, etc.. For which visit do I use the 57 modifier? If I use it the day the decision for surgery was made, the rounding visits become unbillable(global), correct? Any input appreciated.

  2. #2
    Milwaukee WI
    Default Decision was made the first day
    The decision for surgery was made on that first visit. The other visits are good patient care, but they are NOT billable.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Albany, Oregon
    Default Mod 57
    I code for general surgeons. Often a patient is admitted with cholecystitis or sbo (small bowel obstruction), etc. If the case is not emergent, the surgeons will try medical management for a few days. Their consult/H&P indicates this + that surgery may be needed at a later point.

    We don't append mod-57 on that first DOS, but do append the modifier on the e/m for the dos just before surgery if their note indicates that patient is ready for surgery & that surgery is planned for later that day of the next day.

    I can recall only one denial during the 5 years that I've been coding for these guys. That was a Blues patient & we got it overturned when we submitted documentation.

    So.. if the documentation supports the use of mod-57, I'd say to use it.
    Just another opinion

    Pat Kidd, CPC

  4. #4
    Milwaukee WI
    Default Decision for surgery
    I agree with Pat Kidd's scenario .. the decision for surgery wasn't made until after more conservative medical management was tried.

    But the way I read the original scenario the decision for surgery was made at that first visit, but not scheduled until later in the week.

    We've had that type of situation a few times. For example a trauma case comes in with - among other issues - a broken femur. Other issues require more immediate care and the leg can wait a day or two until the patient is more hemodynamically stable. But the decision to operate - eventually - was made the first day. In this type of case, any "subsequent" visits before (or after) ORIF are not coded because they are considered global to the surgery.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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