Janice Posted Tue 16th of October, 2012 19:03:10 PM
i used 99232 with a 57 modifier and the same day the doc did a 31625 the 99232 did not get paid any ideas why would help thanks
SuperCoder Answered Tue 16th of October, 2012 19:16:29 PM
E/M services provided on the day of the day before a major surgical procedure are included as part of the pre-operative services valued in the Relative Value Units for that code. If however, the E/M service provided the day of or the day before a major surgical procedure was the E/M service that resulted in the decision for surgery, it is separately payable. Indicate this by appending modifier 57 to that E/M service.
Modifier 57 is a modifier that is appended to an E/M service to indicate that this was the visit at which the physician decided to perform surgery. It is only used on procedures with a 90 day global period, per CMS, although this is not a CPT® rule. It is only used the day of or before a major surgical procedure. (For a minor surgical procedure, with 0 or 10 global days, no modifier is needed the day before the service, and a 25 modifier is needed the day of the service, if the E/M service was a distinct, separate procedure.)
31625 has global period of 0 days, hence no need of Modifier 57 for that.
Janice Posted Tue 16th of October, 2012 19:37:57 PM
so they are including 99232 with the 31628 is that right
SuperCoder Answered Tue 16th of October, 2012 19:47:37 PM
Yes,if the E/M service was a distinct, separate procedure same day use Modifier 25 with the E/M code.