AAPC - Back to school
Results 1 to 4 of 4

Thread: Mod. 57 if Pt. refused surg.

  1. #1

    Question Mod. 57 if Pt. refused surg.

    AAPC: Back to School
    I have a question that I cannot seem to find an answer for. Case scenerio:
    Surgeon called in on an in patient consult, recommends surgery, according to the report the patient refuses surgery yet I have an op report for the surgery which took place on the same day. Ok, now if I was an auditor and was just looking at the file, and there is no query to the Doc about what happened, and there is a bill submitted for that consult with a mod. 57 on it, would you allow the modifier? My theory is that as of the dictation of THAT consult there was no decision for surgery because the patient refused it. My guess is that the surgeon spoke with the family who convinced the patient to have the surgery, any thoughts on whether I should bill the consult with the Mod. 57.

  2. #2
    Join Date
    Apr 2007
    North Carolina


    Yes...modifier 57 is used to indicate that the provider made the decision to perform surgery; not the patient.

  3. #3


    Hmmm, ok thanks that is not the way I was looking at it!

  4. #4
    Join Date
    Apr 2007
    Baton Rouge


    Maybe also get the doc to append his original dictation about the further discussion in which the patient agreed to the surgery??
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

Similar Threads

  1. Co-Surg Mod 62
    By nenglehart in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 10-14-2015, 07:12 AM
  2. Exam refused by patient
    By cwilson3333 in forum E/M
    Replies: 4
    Last Post: 04-10-2015, 10:55 AM
  3. mod 25 & mod 59 with a 94664 (inhaler)
    By jsa1517 in forum Modifiers
    Replies: 2
    Last Post: 01-29-2010, 02:46 PM
  4. modifier 53 if patient refused procedure?
    By ilvchopin in forum Modifiers
    Replies: 7
    Last Post: 06-15-2009, 01:19 PM
  5. E/M for patient refused to be admitted
    By MDBlais in forum E/M
    Replies: 3
    Last Post: 05-12-2009, 02:00 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.