Wiki EM Modifier???

[dimplez]

Provider saw pt. on Tuesday-determined pt. was too sick to take to the OR. Then saw pt. on Wed, determined pt was deteriorating significantly and need to go STRAIGHT to the OR - so if adding the -57 modifier to Wed visit. What modifier can be added to Tues visit? CAN a modifier be added? Of course, pt. had a major 90-day surgical procedure.

 

[amyjph]

You'd have to determine if both visits support an E/M or not. Or, the provider had already made the decision on Tuesday but they were holding for optimization of the patient. The Wed. visit could possibly be considered part of the global for the major procedure. It depends on the documentation. If they are just rounding for a day or two to optimize, but nothing has changed, and they had already decided on surgery you can't separately report *(usually)*. There are exceptions and outlier things though. It really is dependent on each case/note.
Did the provider actually decide on Tuesday? Was it definitive? Or did they just "possibly" talk about surgery. Then they really decided for surgery on Wed.?
Ortho trauma is a good example, a lot of times patients have multiple injuries so they might be waiting to take someone they already decided needs a fracture ORIF, but they could be seeing them for other things too. In that case a 57 might be appended to an E/M appropriately to get it out of the global from a different major sx.

Modifier 57 Fact Sheet

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