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modifier 57 and device implant

  1. #1
    Default modifier 57 and device implant
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    Please give your input. There are two cardio groups in my town. My group has an electrophysiologist, the other does not, so we get all the device implant patients from the other group. Please give me your opinions on the following:
    1. Patient sees their cardiologist in the other group, who believes the patient needs a pacemaker. That physician admits the patient then my electrophysiologist is called in to evaluate the patient for possible device placement. We have never seen this patient before this visit. After evaluating the patient, the electrophysiologist decides the patient does meet the criteria for device implant and forms a treatment plan which is discussed with the patient and the implant is done the same day. Which physician gets to use the 57 modifier for decision for surgery?
    2. Patient sees their cardiologist in the other group who determines that the patient's pacemaker battery is depleted. That cardiologist admits the patient, who is then seen by our electrophysiologist. Our doc concurs with the primary cardiologist and the procedure is performed. Who gets to use the 57 modifier?
    3. Patient with complete heart block is transferred from another facility that does not have an electrophysiologist. My doc admits the patient and does evaluation. H&P states, "transferred for consideration of device implant". My doc evaluates, forms the treatment plan and the patient receives their device the same day. Does my doc use 57 modifier, or was the decision for surgery made by the physician who transferred the patient to us?

    Sorry this is so long! Thanks for your input.

  2. #2
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    Quote Originally Posted by sherring1 View Post
    Please give your input. There are two cardio groups in my town. My group has an electrophysiologist, the other does not, so we get all the device implant patients from the other group. Please give me your opinions on the following:
    1. Patient sees their cardiologist in the other group, who believes the patient needs a pacemaker. That physician admits the patient then my electrophysiologist is called in to evaluate the patient for possible device placement. We have never seen this patient before this visit. After evaluating the patient, the electrophysiologist decides the patient does meet the criteria for device implant and forms a treatment plan which is discussed with the patient and the implant is done the same day. Which physician gets to use the 57 modifier for decision for surgery?
    2. Patient sees their cardiologist in the other group who determines that the patient's pacemaker battery is depleted. That cardiologist admits the patient, who is then seen by our electrophysiologist. Our doc concurs with the primary cardiologist and the procedure is performed. Who gets to use the 57 modifier?
    3. Patient with complete heart block is transferred from another facility that does not have an electrophysiologist. My doc admits the patient and does evaluation. H&P states, "transferred for consideration of device implant". My doc evaluates, forms the treatment plan and the patient receives their device the same day. Does my doc use 57 modifier, or was the decision for surgery made by the physician who transferred the patient to us?

    Sorry this is so long! Thanks for your input.
    I would think that for all these scenarios it will be YOUR provider eletrophysiologist who will be putting the -57 modifier on his E/M code. He's the one who I think ultimately is making the decision for surgery.

    Jessica CPC, CCC

  3. #3
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    Thanks Jessica. That's pretty much how I see it also, but I'm concerned about this being considered "prescheduled" and "preoperative care" since the other cardiologist took the step of going ahead and admitting the patient himself. It seems that his intention is that the patient will get a device even though that can't happen without my doc evaluating the patient.

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