Pulmonology Coding 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. What are we doing wrong? California Subscriber Answer: If you're appending modifier -57 (Decision for surgery) to 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 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. In fact, Medicare doesn't recognize modifier -57 for procedures with less than 90 global days. If your pulmonologist 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.