Page 1 of 2 12 LastLast
Results 1 to 10 of 16

57 modifier

  1. Default 57 modifier
    Medical Coding Books
    Just wondering if anyone has any info on this or not? One of our orthopaedic docs sat in on a seminar that stated we should not be billing the office visit with a 57 for fracture care?

    Anyone have any info or thoughts on that?

  2. #2
    Default
    It depends on if the patient comes in with a dx of fracture or not. If they have been to the emerency room and were diagnosed with a fracture then I would not use the 57 modifer for the first office visit because you already know that it will most likely need to be set.

    However if the patient does not know it is borken and has not been to the ER then you should be able to use the 57 for the first office visit.
    EVELYN KIM , MBA, CPC, CPMA,CRC

  3. Default
    I see your point on that but what if we just make an appt for a fx and we bill a non operative fx fee should we also bill an office visit with a 57?

  4. #4
    Location
    Greater Pittsburgh
    Posts
    390
    Default
    If you have determined the fracture and are going to treat the patient, then you would use either a 25 or 57 modifier on the office visit EM code depending on the global post op time for the CPT code; 90 days you would use the 57 modfr.; or 10 days post op you would use the 25 modifier. (that's not just for fxs but any CPT codes/check the global).
    jdemar, CPC, CMA

  5. Default
    ok I just want to be sure that we are allowed to bill the E/M as well as the closed fx fee(non operatively) I understand the difference between when to use the 25 and the 57. It is more of is there some written rule or guideline we have to follow in orthopaedics when it comes to the issue above?

  6. Default
    You would NOT bill an E&M with closed fracture care, without manipulation. The only time you could bill an E&M with a fracture code is when you do surgery or when you do closed manipulation. If you do not manipulate the fracture or do surgery, there is no E&M attached. Example: 25600 (no E&M). 25605 (E&M with 57 modifier).
    Last edited by madgejones10; 12-18-2011 at 01:34 PM.

  7. Default
    I thougth we were taught that any E&M used to evaluate and make the decision to take on management of a fracture, and then billed with open, Closed reduction or just Closed treatment (no manipulation) codes with 90d globals, we were supposed to append the mod -57 to the E&M. It seems like every time we attend a conference, the instructions change. Is it documented somewhere regarding not billing E&M -57, with closed fracutre care w/o manipulation?

  8. #8
    Default
    Quote Originally Posted by madgejones10 View Post
    You would NOT bill an E&M with closed fracture care, without manipulation. The only time you could bill an E&M with a fracture code is when you do surgery or when you do closed manipulation. If you do not manipulate the fracture or do surgery, there is no E&M attached. Example: 25600 (no E&M). 25605 (E&M with 57 modifier).
    this is not true. you can bill E/M with closed fractures even if manipulation is not necessary. We do it daily. Here how it looks like. E/M + Q4038+28470. Never ever had any problems with any payer.

  9. Default
    Thank you for your input! Do you work for a large ortho group?

  10. Default
    Armen, are you appending any modifier to the E/M? Thanks so much, Mary

Page 1 of 2 12 LastLast

Similar Threads

  1. Replies: 2
    Last Post: 09-18-2015, 02:17 PM
  2. Modifier 59 vs Modifier 91 for Laboratory
    By leahrey in forum Modifiers
    Replies: 1
    Last Post: 06-23-2015, 01:01 PM
  3. MODIFIER PT VS MODIFIER 33 Screening Colonoscopy
    By Ann Johnson in forum Modifiers
    Replies: 2
    Last Post: 07-19-2012, 08:08 AM
  4. Modifier 58 versus Modifier 78
    By Ramona03 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-04-2012, 01:10 PM
  5. Modifier 51 Versus Modifier 59
    By Sborkowski in forum Modifiers
    Replies: 3
    Last Post: 05-26-2009, 04:59 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.