# What modifier??



## cvand1972 (Nov 13, 2009)

Our local Medicare, NGS, is looking for a modifier on a hospital Consult and obviously they won't tell us so I've got to figure it out on my own.
Anyway, patient is seen for a Hospital Consult (99253) on 10/21.  He then had a Cath by a different provider the same day (93510-26).  He then had a pacemaker implant on 10/22 (33208) by the same provider that did the Consult on 10/21.  What modifier do you think they are looking for on the Consult?  I don't think it has anything to do with the Cath, but I could be wrong as we are new to these procedures.


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## Jess1125 (Nov 13, 2009)

I would say -57 since this is being done the day prior to the pacemaker insertion which has a 90 day global so long as this consult was the "decision for surgery".


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## Cyndi113 (Nov 13, 2009)

More than likely they are looking for  -25 if the cath was done on the same day. Was the cath done by a provider from the same group. If so, definitely -25.


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## cvand1972 (Nov 13, 2009)

We had the same idea but we tried the 25 and they still denied it.  Yes, it was done by a provider in the same group.


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## Cyndi113 (Nov 13, 2009)

That's weird. Then I agree with Mod -57.


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## Mjones7 (Nov 23, 2009)

I would bill the consult with a -57.  I wonder, did the "diff provider" that performed the cath the same day as your consult billed a consult code in addition to the cath and now Medicare will not pay for your consult as the same svc is being billed on the same day?


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