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ER or OV Code?

Stacey Posted Wed 02nd of May, 2012 13:11:20 PM

Pt was seen in the ER. The ER staff called Dr and patient walked across the parking lot and was seen in our office. A decision for surgery was made and the patient went back over to the hospital for iridotomy. I want to bill a NP E&M with a modifier of 57 (decision for surgery) along with the iridotomy. Is this correct? The patient was not seen by us in the ER.......????

SuperCoder Answered Thu 03rd of May, 2012 08:38:22 AM

Yes. I believe you can bill it under your provider's NPI with E/M code with modifier -57 if physician reviewed the doc. but it need some time for additional research. The procedure performed within 24 hours should be major. If it is minor 0-10 days, you should go for -25. Normally NP can bill his/her NPI's number for E/M visit, but for decision for surgery, need to research for some additional guideline. I'll update you soon.

SuperCoder Answered Thu 03rd of May, 2012 09:53:56 AM

As far as my research is concerned, you can't bill modifier -57 for NP. Only E/M visit can be billed for NP. Modifier -57 should only be billed by a physician who decides to treat a condition surgically on the day of, or the day before a procedure with a 90-day global period means surgeon should make the decision to perform surgery for a patient with an emergent condition that requires immediate surgery. Also modifier -57 is not applicable if the physician provided the service on the day before, or the day of the procedure with a 0 or 10-day global period. Modifier -25 should be appended to an E/M that is performed on the same day as a 0- or 10-day global period procedure. No modifier would be required of the E/M took place the day before the procedure.

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