Wiki Decision for surgery

[mcamp]

Breast surgeon sees a new patient in the office for newly diagnosed breast cancer. The decision is made for major surgery. This is scheduled for the following week. What is the appropriate modifier to use? I looked at modifier 57 and wondered if this modifier can be used when the surgery is scheduled for a week out?

 

[Lajolla21]

No.

no, the dec. for surgery must be made the day before or the day of the actual surgery.

(this is why you do not see more 57- modifiers on e/m-surgery claims.......that pay).

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