Sadna Posted Mon 22nd of July, 2019 18:36:09 PM
When a decision is made to perform a procedure during the subsequent visit at a hospital what is the best modifier to use. Example: How do we bill 99233 and 33968 on the same date of service. Do we bill 99233 with modifier 25 or 57? What rules apply to Medicare, Medicaid and Commercial?
SuperCoder Answered Tue 23rd of July, 2019 04:14:09 AM
Thanks for your question.
If an Evaluation and Management (E/M) service resulted in the initial decision to perform surgery either the day before a major surgery (90 day global) or the day of a major surgery, then modifier 57 should be appended to Evaluation and Management (E/M) service code.
But since the procedure (33968) is a minor surgery, you should not report E/M code separately.
E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service.
This rule is applicable to Medicare and most other commercial insurances. Please get in touch with the representative of the particular insurance for more information.
Please feel free to write if you have any question.