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Follow up on NP Coding listed 2 weeks ago

Lori Posted Fri 04th of April, 2014 18:23:50 PM

In the reply you state that an e/m can be billed with the 62311 at the initial visit. Just add -25. If the e/m is all about the 62311 and our provider agrees with the decision to do the 62311 how is the e/m separately identifiable from the procedure?

SuperCoder Answered Mon 07th of April, 2014 12:54:36 PM

The physician often evaluates new patients, and then has them return for caudal injections. They typically will have a new patient for whom the physician schedules an injection (62311). The injection takes place in office, usually within two weeks of the initial visit. It has been suggested that use the -57 modifier with 99204 (office or other outpatient visit for the evaluation and management of a new patient ...) because 62311 is considered surgery, and it was at the initial visit that the physician decided to schedule the injection.

The question here is the correct use of modifier -57. Major surgeries have 90-day global periods, the preoperative portion of which begins one day prior to surgery. The use of modifier -57 keeps an E/M service from being bundled within that global surgical period. It is applied when a physician sees a patient (at an E/M office visit or emergency department consult, for example) and decides that immediately, later that day, or the following day, the patient needs surgery. The modifier essentially says to the payer: I didnt know the patient would need surgery until I examined him or her in the initial E/M visit, so the E/M portion is a separately billable item. Modifier -57 would be appended to the E/M code reported on the day of or the day before major surgery when the E/M service resulted in the decision to perform surgery.

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