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Pulmonology Coding Alert

Reader Question:

Avoid Modifier 57 For Procedures with Zero Global Days

Published on Sun Oct 28, 2012

Question: Our pulmonologist recently performed an endobronchial biopsy after he made the decision to perform the procedure following an evaluation of the patient. I reported the evaluation with 99232 and reported the biopsy procedure with 31625. I appended modifier 57 to 99232. The claim for 31625 got paid but 99232 was not paid. What should I do to get the claim for the E/M code to be paid?Texas SubscriberAnswer: E/M services provided on the day of the day before a major surgical procedure are included as part of the pre-operative services valued in the Relative Value Units for that code. If however, the E/M service provided the day of or the day before a major surgical procedure resulted in the decision for surgery, it is separately payable. You will have to append modifier 57 (Decision for surgery) to the E/M service.Modifier 57 indicates that this was the visit at which [...]
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