Blackhorse Posted Thu 04th of January, 2018 19:20:16 PM
Patient fell and injured his left ankle, X-ray shows a comminuted displaced fracture of calcaneal body (S92.012A). Our doctor was referred for consultation by member's PCP. After consultation, our doctor decides to do a surgery (28415) on the next day. My question is: can we bill 99245-57 on the consultation date?
SuperCoder Answered Fri 05th of January, 2018 02:28:05 AM
Yes, 57 modifier should be used with the consultation CPT code 99245. 57 modifier indicates decision for surgery was taken during the consultation visit. Please ensure you are using the correct consultation code as per the medical documentation. Medical documentation should be strong enough for comprehensive history, comprehensive examination and Medical decision making of high complexity to bill CPT code 99245.