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Use of modifier 57 help

  1. #1
    Default Use of modifier 57 help
    Medical Coding Books
    Hello everyone:
    Question... Patient first visit to clinic, he has an ankle fracture (MCR patient) Dr decided to operate in two days. He performed a pre-operative exam on today visit. Should I append a mod 57 or not. Please help, thanks
    Mildred Nieves, CPC

  2. #2
    Location
    Green Bay, WI
    Posts
    47
    Default
    I don't think you need to append a 57, because the surgery is planned to be done 2 days. Normally this modifier is used if the E/M visit is on the day of or the day before the surgery. The link below may be helpful.


    http://wpsmedicare.com/part_b/education/modifier_57.pdf


    Hope this helps.
    Alaina M. Boncher, CPC

  3. #3
    Default
    Thank a lot Alaina for your help, is great to have this information in black and white. I just shared with the others coders, thanks again for your help.
    Mildred Nieves, CPC

  4. Smile 57 modifier
    I have been informed that 57 modifiers will no longer be accepted with Medicare patients- for new patient status. According to this rule no 57modifier would be accepted on this claim. Hope with helps

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by MichelleM View Post
    I have been informed that 57 modifiers will no longer be accepted with Medicare patients- for new patient status. According to this rule no 57modifier would be accepted on this claim. Hope with helps
    Do you have a reference for this? The citation below is still located in Medicare's Manual.

    CPT Modifier “-57” - Decision for Surgery Made Within Global Surgical Period

    Carriers pay for an evaluation and management service on the day of or on the day before a procedure with a 90-day global surgical period if the physician uses CPT modifier “-57” to indicate that the service resulted in the decision to perform the procedure. Carriers may no pay for an evaluation and management service billed with the CPT modifier “-57” if it was provided on the day of or the day before a procedure with a 0 or 10-day global surgical period.

  6. Default
    Do you have an updated link for this? This one is not working. Please and thank you for your help!!

  7. #7
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by pixeedustt@yahoo.com View Post
    Do you have an updated link for this? This one is not working. Please and thank you for your help!!
    I can provide the link for my reference...

    4. Evaluation and Management Service Resulting in the Initial Decision to Perform Surgery

    Page 96


    http://www.cms.gov/manuals/downloads/clm104c12.pdf

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