Cardiology Coding Alert

Question: The cardiologist performed a level 3 consult for an inpatient and determined the patient needed an IVC filter (37620) placed later that day. Should I append modifier 57 to the E/M code?

South Carolina Subscriber

Answer: Yes, you should append modifier 57 (Decision for surgery) to 99253 (Inpatient consultation for a new or established patient ...) in this case.

CPT's modifier 57 definition states you should append it to an E/M "service that resulted in the initial decision to perform the surgery," as in your example.

'Major' must: Medicare instructs contractors that you should use modifier 57 only with major surgeries, which are procedures with a 90-day global period. The Medicare Physician Fee Schedule assigns a 90-day global period to 37620 (Interruption, partial or complete, of inferior vena cava by suture, ligation, plication, clip, extravascular, intravascular [umbrella device]).

And Medicare instructs carriers that E/M services "on the day before major surgery or on the day of major surgery that result in the initial decision to perform the surgery are not included in the global surgery payment for the major surgery and, therefore, may be billed and paid separately" (Medicare Claims Processing Manual, Chapter 12, Section 40.2).