# 57 modifier



## cvzzz (Dec 13, 2011)

Just wondering if anyone has any info on this or not?  One of our orthopaedic docs sat in on a seminar that stated we should not be billing the office visit with a 57 for fracture care?

Anyone have any info or thoughts on that?


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## Evelyn Kim (Dec 13, 2011)

It depends on if the patient comes in with a dx of fracture or not.  If they have been to the emerency room and were diagnosed with a fracture then I would not use the 57 modifer for the first office visit because you already know that it will most likely need to be set.

However if the patient does not know it is borken and has not been to the ER then you should be able to use the 57 for the first office visit.


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## cvzzz (Dec 14, 2011)

I see your point on that but what if we just make an appt for a fx and we bill a non operative fx fee should we also bill an office visit with a 57?


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## jdemar (Dec 14, 2011)

If you have determined the fracture and are  going to treat the patient, then you would use either a 25 or 57 modifier on the office visit EM code depending on the  global post op time for the CPT code;  90 days you would use the 57 modfr.; or 10 days post op you would use the 25 modifier.  (that's not just for fxs but any CPT codes/check the global).


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## cvzzz (Dec 14, 2011)

ok I just want to be sure that we are allowed to bill the E/M as well as the closed fx fee(non operatively) I understand the difference between when to use the 25 and the 57.  It is more of is there some written rule or guideline we have to follow in orthopaedics when it comes to the issue above?


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## madgejones10 (Dec 18, 2011)

You would NOT bill an E&M with closed fracture care, without manipulation.  The only time you could bill an E&M with a fracture code is when you do surgery or when you do closed manipulation.  If you do not manipulate the fracture or do surgery, there is no E&M attached.  Example:  25600  (no E&M).   25605  (E&M with 57 modifier).


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## MMadrigal (Dec 18, 2011)

I thougth we were taught that any E&M used to evaluate and make the decision to take on management of a fracture, and then billed with open, Closed reduction or just Closed treatment (no manipulation) codes with 90d globals, we were supposed to append the mod -57 to the E&M.   It seems like every time we attend a conference, the instructions change.    Is it documented somewhere regarding not billing E&M -57, with closed fracutre care w/o manipulation?


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## armen (Dec 19, 2011)

madgejones10 said:


> You would NOT bill an E&M with closed fracture care, without manipulation.  The only time you could bill an E&M with a fracture code is when you do surgery or when you do closed manipulation.  If you do not manipulate the fracture or do surgery, there is no E&M attached.  Example:  25600  (no E&M).   25605  (E&M with 57 modifier).



this is not true. you can bill E/M with closed fractures even if manipulation is not necessary. We do it daily. Here how it looks like. E/M + Q4038+28470. Never ever had any problems with any payer.


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## cvzzz (Dec 21, 2011)

Thank you for your input!  Do you work for a large ortho group?


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## MMadrigal (Dec 21, 2011)

Armen, are you appending any modifier to the E/M?  Thanks so much, Mary


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## armen (Dec 22, 2011)

cvzzz said:


> Thank you for your input!  Do you work for a large ortho group?



I work for a practice with two docs. we see about 35 patients a day.


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## armen (Dec 22, 2011)

MMadrigal said:


> Armen, are you appending any modifier to the E/M?  Thanks so much, Mary



If I bill fracture care or any other surgical procedure with 90 days global periode, I bill E/M with 57 modif. If global is 10 days or 0, then modif 25. I dont recall any fracture care code with less than 90 days global, so mostly 57 is used. Maybe what people were trying to say is that you can not bill cast application code since it is included in Fx care code. All this info can be found on internet. I would check AAOS web site.


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## campy1961 (Jan 9, 2012)

I know this is probably late but mod 57 is only used when a 'decision for surgery' is determeined.  You can only use this mod a couple of days before as an OP setting or the day of surgery if IP.


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## caromissunc1 (Jan 10, 2012)

*57 Modifier*

You would not put a 57 modifier on an office visit if fracture care was initiated prior to the first office visit.  We start fracture care on patients all the time in the ER.


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## armen (Jan 19, 2012)

campy1961 said:


> I know this is probably late but mod 57 is only used when a 'decision for surgery' is determeined.  You can only use this mod a couple of days before as an OP setting or the day of surgery if IP.



You have to use modifier 57 on the day of or the day prior to the service with 90 days global period to get paid for E/M. Any other procedure that has less than 90 days global (i.e 0, 10) can be billed with E/M + modif 25. You can find this info in medicare manual. An E/M "a couple of days before the surgery" does not have to have a modifier unless billed with other services since global period starts one day prior to surgery (procedures with global period more than 0 days).
_C. CPT Modifier “-57” - Decision for Surgery Made Within Global Surgical Period
Carriers pay for an evaluation and management service on the day of or on the day before a procedure with a 90-day global surgical period if the physician uses CPT modifier “-57” to indicate that the service resulted in the decision to perform the procedure. Carriers may no pay for an evaluation and management service billed with the CPT modifier “-57” if it was provided on the day of or the day before a procedure with a 0 or 10-day global surgical period._


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## armen (Jan 19, 2012)

caromissunc1 said:


> You would not put a 57 modifier on an office visit if fracture care was initiated prior to the first office visit.  We start fracture care on patients all the time in the ER.



If fracture care was initiated prior to visit (patient has been seen in the ER) then you dont have an E/M at all, since patient would be in global period. So yes, you would not have a place to put 57 or any other modifier.


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