Wiki 57 Mod on everything

[Lynda Wetter]

Just curious to the different responses on this one.

What are your opinions on someone that puts a 57 modifier on 95% of all the office visits done.
Weather a procedure was done or not and global days or not. Just blanketing the 57......?

 

[MnTwins29]

Wow

Talk about screaming "Please, come and audit me!" The person responsible for assigning modifiers needs some education on when it is appropriate to use this modifier.

 

[Lynda Wetter]

I agree, but how would you suggest trying to educate someone if it seems to be a touchy subject. I have pulled what info I can from CMS fact sheets and other resources but I cant find anything to still push my point. CPT appendix A and the NCCI policy manual is enough for me but not for some.
Thanks for your help

 

[LLovett]

http://www.wpsmedicare.com/j8macpartb/resources/modifiers/modifier-57.shtml

http://www.wpsmedicare.com/j8macpartb/resources/modifiers/modifierintro.shtml

Modifiers
Procedure codes may be modified under certain circumstances to more accurately represent the service or item rendered. For this purpose, modifiers are used to add information or change the description of service in order to improve accuracy or specificity. The documentation of the service provided must support the use of the modifier.


http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R954CP.pdf

When a carrier has completed a review and determined that a high usage rate of modifier “-57,” the carrier must complete a case-by-case review of the records. Based upon this review, the carrier will educate providers regarding the appropriate use of modifier “-57.” If high usage rates continue, the carrier may impose prepayment screens or documentation requirements for that provider or group.


Not sure who your carrier is but hopefully this is helpful information. The first 2 links are to WPS, they have the best info about individual modifiers and usage in my opinion. The last is to a CMS publication. I copied and pasted the part that should make any provider take notice and change their ways.

Good luck,

Laura, CPC, CPMA, CEMC