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Modifier -57

Marla Posted Mon 24th of October, 2016 09:37:15 AM
1) If a patient is seen by physician in the hospital and the next day another physician from that same practice sees the patient again and he recommends surgery that same day, does the initial visit from the physician that saw the patient the day before need to be billed with a -57 modifier (even though he did not recommend surgery at that time).
Marla Posted Mon 24th of October, 2016 09:40:42 AM
As I understand, a procedure with a 90 day global includes the 24 hour period prior to surgery and in order for an E/M code to be paid within that 24 hour period, you would need to use a -57 modifier; however, that physician did not recommend surgery.
SuperCoder Answered Tue 25th of October, 2016 06:11:29 AM

To append modifier 57 properly, one of the points says that the E/M service must prompt the surgical procedure that follows. However, different payers have different guidelines that determine reimbursement for E/M services with modifier 57, therefore please check with individual payers for specific information. Thank you.

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