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Modifier 57 and Solid Organ Transplant

  1. Default Modifier 57 and Solid Organ Transplant
    Clearnace Sale
    We are having a debate as to the appropriateness of using the modifier -57 when patients are called in to receive a solid organ transplant (kidney, liver, pancreas). One side of the debate feels the decision for surgery was made when the patients condition has become exacerbated to the point where the patient is placed on the national UNOS waiting list for a transplant. The thought process being the provider made the decision that the patient needed surgery by placing the patient on the list to receive a needed transplant.

    The other side of the debate is that when an organ does become available 2 or 3 transplant candidates on the UNOS waiting list are called in. The provider assesses each candidate to determine which patient is best suited to receive the organ donation.

    The question is this: Can the provider bill an admission with a -57 modifier on the patient that was called in that receives the organ or is the E&M bundled with the surgery itself? Thanks in advance.

  2. #2
    Milwaukee WI
    Default Medical necessity
    Much will depend on the documentation (of course), but I would say it is medically necessary to evaluate the patient and make a decision Yes or No as to whether to perform surgery.

    So, yes, -57 modifier.

    F Tessa Bartels, CPC, CEMC

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