Results 1 to 8 of 8

Modifier 57 - discussing with a general surgeon

  1. #1
    Default Modifier 57 - discussing with a general surgeon
    Exam Training Packages
    Would modifier 57 be used on the facility side, physician side or both when the ED physician admits a patient to the OR for appendectomy after discussing with a general surgeon? Or would mod 57 only be used by the general surgeon?

  2. #2
    Default
    Modifier 57 can only be used by the general surgeon "IF" & "ONLY IF" the surgeon performed a consult (met the requirements of a consult and then made the decision to perform the surgery. A coder must be careful using modifier 57. All of the requirements of a consult must be met and the actual decision of performing a surgical procedure must be decided after preforming the exam and reviewing diagnostic tests.

    I hope this helps.

    Peggy

  3. #3
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    jccoder - I'd give the decision for surgery to the whoever made that decision (form what you wrote, I'd say ED doc made the call - surgeon was ready for the procedure). I don't see anywhere in my CPT guidelines that the decision for surgery code .57 can only be used on a "consult" code, or that it can only be used by surgeons. I read the definition as: "an evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service." However, I do believe it can only be used in connection with major surgical procedures (90 day global). I'm sure the appendectomy has a 90 day global.
    Personally, I've never used it on an ED E/M - I have used it in the past on several regular office visit E/M's that resulted in the decision to do a major surgical procedure.
    Donna, CPC, CPC-H

  4. Default
    I've never seen this documented anywhere, but I would expect the only provider who would have a need for this modifier would be the one who is performing the actual surgical procedure. This modifier would be used either the day of surgery or one day prior indicating the "decision for surgery" was made at this visit. It would prevent the service from being denied "global" to the surgery. Another provider's service wouldn't deny as global. I also don't believe its use is limited to consultations as I've used it on hospital admissions, new/est office visits and ED visits.

    ~L
    CPC, CGSC, COSC

  5. #5
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    hi Treetoad - yes, I've used it on new/est EM's also, the day before and day of surgery. but, (and maybe I used the code wrong) ...I have used it on the provider (PCP) who decided to send the person to surgery but wasn't the surgeon. Example being, pt patient presented with severe abdominal pain - vomiting, to PCP (on a walk-in emergency type visit) - PCP examined, ran tests - determined appendicitis and need for surgery ASAP - PCP did not do the appendectomy but was the one that made that decision for it - I appended the .57 modifier to the PCP's E/M so it wouldn't get caught up in a global issue.
    I'd appreciate your advice on this - do you think I shouldn't have used the .57?
    thanks!
    Donna, CPC, CPC-H

  6. Default
    Hi Donna,
    I don't think using modifier 57 is necessary for anyone other than the surgeon. If the PCP service denied, it would be an error on the carrier's part and I would appeal.

    ~L
    CPC, CGSC, COSC

  7. #7
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    hmm... I see Now I'll have to find out just how they paid! - Hopefully putting the modifier on it didn't mess things up either. I'll check in on that more with billing. Thanks for the input!
    Donna, CPC, CPC-H

  8. #8
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    The 57 modifier is not used on the facility side, it is a physician modifier.

Similar Threads

  1. Replies: 2
    Last Post: 09-18-2015, 01:17 PM
  2. Modifier 59 vs Modifier 91 for Laboratory
    By leahrey in forum Modifiers
    Replies: 1
    Last Post: 06-23-2015, 12:01 PM
  3. MODIFIER PT VS MODIFIER 33 Screening Colonoscopy
    By Ann Johnson in forum Modifiers
    Replies: 2
    Last Post: 07-19-2012, 07:08 AM
  4. Modifier 58 versus Modifier 78
    By Ramona03 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-04-2012, 12:10 PM
  5. Modifier 51 Versus Modifier 59
    By Sborkowski in forum Modifiers
    Replies: 3
    Last Post: 05-26-2009, 03:59 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?

Login

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.

Get OurFREE2017SalarySurvey.

We'll email you a link to our 2017 Healthcare Salary Survey when it is available so you can see your earning potential.