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57 modifier

  1. #11
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    Medical Coding Books
    Quote Originally Posted by cvzzz View Post
    Thank you for your input! Do you work for a large ortho group?
    I work for a practice with two docs. we see about 35 patients a day.

  2. #12
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    Quote Originally Posted by MMadrigal View Post
    Armen, are you appending any modifier to the E/M? Thanks so much, Mary
    If I bill fracture care or any other surgical procedure with 90 days global periode, I bill E/M with 57 modif. If global is 10 days or 0, then modif 25. I dont recall any fracture care code with less than 90 days global, so mostly 57 is used. Maybe what people were trying to say is that you can not bill cast application code since it is included in Fx care code. All this info can be found on internet. I would check AAOS web site.

  3. Default
    I know this is probably late but mod 57 is only used when a 'decision for surgery' is determeined. You can only use this mod a couple of days before as an OP setting or the day of surgery if IP.

  4. Default 57 Modifier
    You would not put a 57 modifier on an office visit if fracture care was initiated prior to the first office visit. We start fracture care on patients all the time in the ER.

  5. #15
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    Quote Originally Posted by campy1961 View Post
    I know this is probably late but mod 57 is only used when a 'decision for surgery' is determeined. You can only use this mod a couple of days before as an OP setting or the day of surgery if IP.
    You have to use modifier 57 on the day of or the day prior to the service with 90 days global period to get paid for E/M. Any other procedure that has less than 90 days global (i.e 0, 10) can be billed with E/M + modif 25. You can find this info in medicare manual. An E/M "a couple of days before the surgery" does not have to have a modifier unless billed with other services since global period starts one day prior to surgery (procedures with global period more than 0 days).
    C. CPT Modifier “-57” - Decision for Surgery Made Within Global Surgical Period
    Carriers pay for an evaluation and management service on the day of or on the day before a procedure with a 90-day global surgical period if the physician uses CPT modifier “-57” to indicate that the service resulted in the decision to perform the procedure. Carriers may no pay for an evaluation and management service billed with the CPT modifier “-57” if it was provided on the day of or the day before a procedure with a 0 or 10-day global surgical period.

  6. #16
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    Quote Originally Posted by caromissunc1 View Post
    You would not put a 57 modifier on an office visit if fracture care was initiated prior to the first office visit. We start fracture care on patients all the time in the ER.
    If fracture care was initiated prior to visit (patient has been seen in the ER) then you dont have an E/M at all, since patient would be in global period. So yes, you would not have a place to put 57 or any other modifier.

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