Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

57 modifier

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.

Related Topics