Practice Management Alert

Question: We use modifier -57 on separately identifiable E/M services during which the decision for surgery is made, either on the day before or the day of a surgical procedure. We make sure the service warrants a separate charge, but we still get denied for the claims. Do you have any clue as to what we're doing wrong? California Subscriber Answer: If you're tacking modifier -57 (Decision for surgery) on minor surgical services, that's probably why you're seeing denials for these charges.

Modifier -57 is used for separately identifiable E/M services rendered the day before or day of a major surgical package. Modifier -57 tells the payer, "We know that this preoperative visit is part of the surgical package, but the physician needed a separate, identifiable E/M in order to reach the decision to perform surgery." Usually services requiring that type of E/M visit have 90-day global packages. Minor services do not require that type of E/M visit from a physician. If your physician does a consultation the day before or the day of surgery, and the physician decides that the patient needs surgery, you should put modifier -57 on your consultation codes. You Be the Expert and Reader Questions provided by Mary Dykstra, RT, CPC, billing manager at Medical Center of Stafford in the Roanoke, Va., area; Judith Richardson, RN, MSA, CCS-P, a senior consultant with Hill & Associates; reviewed by Catherine Brink CMM, CPC, president of Healthcare Resource Management Inc., in Spring Lake, N.J.