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-25 modifier vs. -57 modifier

  1. #1
    Question -25 modifier vs. -57 modifier
    Medical Coding Books
    We are a cardiology practice and our physicians implanted a permanent pacemaker, 33208, on 9/30/2011 while patient was in-patient at the hospital. He was also following this patient and we charged 99232 on 9/29 and 99238-25 on 9/30/2011. Medicare paid for both the pacemaker implant on 9/30 and the hospital discharge but are denying 99232 billed on 9/29 as pre-op care. What would be an appropriate modifier to use in this situation?

    Thanks.

  2. #2
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    Quote Originally Posted by amym View Post
    We are a cardiology practice and our physicians implanted a permanent pacemaker, 33208, on 9/30/2011 while patient was in-patient at the hospital. He was also following this patient and we charged 99232 on 9/29 and 99238-25 on 9/30/2011. Medicare paid for both the pacemaker implant on 9/30 and the hospital discharge but are denying 99232 billed on 9/29 as pre-op care. What would be an appropriate modifier to use in this situation?

    Thanks.
    Procedure code 33208 has a 90 day global period, which starts the day before the procedure. If the decision for surgery was made while the patient was in the hospital, then you can add modifier 57 to the 99232 for 9/29/11. Was there a different diagnosis code used for the discharge? Was the patient being followed for a different problem at the same time? Usually once a surgical procedure is done, all care becomes part of that procedure and as such the discharge should not be paid separately.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. Default senior coding specialist
    Actually, I'm surprised Medicare paid for the discharge. If during the hospital visit on the 29th, the decision was made to implant the pacemaker the next day. then you would need a modifier 57.

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