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Modifer -57 help, New to Ortho

  1. #1
    Post Modifer -57 help, New to Ortho
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    What is the correct use for -57, if doctor sees pt in office and decides to do surgery that day must I use -57, or if doctor sees pt but states in note that surgery will be the following day do I still use it. Thanks for any suggestions

  2. #2
    Greeley, Colorado
    Modifier -57 is used on the E/M for the day of or the day prior to surgery, to indicate the decision for surgery was made at that encounter.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    So, if the doc indicates in dictation that surgery is to be performed that day or the next I should always use -57?

  4. #4
    Greeley, Colorado
    Yes, for the E/M code; and as long as the planned procedure has a 90 day global period (most ortho procedures do).
    Lisa Bledsoe, CPC, CPMA

  5. #5
    The phsyician will still get paid for the E/M code though, correct?

  6. Default
    Yes, the dr will get paid for the OV.
    Also, say dr did a OV on the day before sx and the day of sx, then the OV on the day before gets billed with the 57 mod and the day of sx is not billable.
    Hope I didn't confuse you.

  7. #7
    Greeley, Colorado
    Yes the doctor should get paid. You might have to appeal as some insurances are starting to deny -57 the first time around.
    Lisa Bledsoe, CPC, CPMA

  8. #8
    Thanks everyone for your help! A little rusty on surgery coding, it has been a while! Thanks again!

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