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Mod. 57 if Pt. refused surg.

  1. Question Mod. 57 if Pt. refused surg.
    Medical Coding Books
    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
    North Carolina
    Yes...modifier 57 is used to indicate that the provider made the decision to perform surgery; not the patient.

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

  4. #4
    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

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