Wiki Consult with Cath

[staticsis2]

Can someone assist me. If we bill a consult and the doctor decides the next day to do a cath we should use modifer 57? If it is on the same day 25?

Also, when we schedule a pt for out patient cath can we bill a dc of 99217 or is that inclusive.

Thank you all for any help.

Dar

 

[sllindsey]

If the procedure is done on the same day and holds a 0-10 global use the 25. If he does the procedure the next day, if it holds a 90 day global then you use the 57. Not sure what type of cath you are referring to. I work in urology so I am thinking about a foley cath... So in that case 25 for same day and no modifier for the next day.

 

[j.monday7814]

I'm assuming this is for a cardiac cath, if so then a -25 modifier is appropriate. just like stated above, the modifier is based on the global period for the code.

 

[Amanedmaiston]

You only use modifier 57 if it is a major surgery. A heart cath is not a major surgery. Medicare has good articles explaining this. Also you would not bill 99217 with an outpatient cath--99217 is for patients in observation status.

 

[mhigdon]

Cadiac Cath with Consult...HELP

If the physician does a consult or an Admission and then decides to do a cardiac cath, nuclear stress test or an echo can you attach the 25 modifier to it? We are not getting paid for the consult and it is significantly less reimbursement for an echo or stress test interp. Is it appropriate to bill the 25 with the consult or admission for the following tests?

Cath & Consult
Echo & Consult
Nuclear Stress test & consult.

 

[espressoguy]

I've never put a 25 on an E&M when an echo is done and haven't had any problems getting paid. I do add the 25 when a nuclear stress test or cath is done same day.

 

[j.monday7814]

I've never put a 25 on an E&M when an echo is done and haven't had any problems getting paid. I do add the 25 when a nuclear stress test or cath is done same day.

I'm surprised, we get instant denials when we don't have a modifier on an echo. It has 0 day global just like nukes, stress tests, and caths so I don't understand why they would pay both codes without the modifier 25