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Thread: Modifier 24 & 57

  1. #1

    Default Modifier 24 & 57

    AAPC: Back to School
    Can both modifier 24 & 57 be billed on an EM consult?

  2. #2

    Default modifier 24 &57

    Please anyone any suggestions?

  3. #3
    Join Date
    Apr 2007

    Default Yes

    I would say yes, i bill -24 and -57 with office e/m. I don't bill too much consults so i can't say i'm 100% sure but i don't see why not.

  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default An example to illustrate

    Modifier 24 is for an UNRELATED E/M service in the postoperative period
    Modifier 57 is for the Decision for Surgery on an E/M service the same day of, or the day prior to, a major surgical procedure (90 day global period).

    Patient has a mastectomy on 03-10-10 by General Surgeon A

    Patient presents to office with RLQ pain and fever on 04-20-10; General surgeon A evaluates patient, diagnosis acute appendicitis, sends patient to hospital where he performs appendectomy the same day.

    He would append a modifier -24 AND modifier -57 to the E/M visit for this date of service because it is unrelated to the mastectomy (mod 24) and it is the decision for major surgery for the appendectomy (mod 57).

    If patient saw a totally different surgeon from a different practice or different specialty for the RLQ pain, no -24 modifier would be needed as the global would not apply. Would still need the -57 modifier.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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