Mjones7
Networker
I have an issue and would appreciate your insight. I have some MD's who bill pre op visits as E/M's and I have others who bill what we call an N/C. I am attempting to streamline. I suggested we bill an E/M for pre-op services done prior to one day of surgery without a -57 as it should not be warranted as we are not in a defined global period. In the event the pre-op is performed the day of, I would bill an E/M with the -57. My Docs state they spend a great deal of time in their pre op encounters. I would like to capture the reimbursement but want to do it the correct way. I have reviewed the following:
CMS Physician Manual (Rev. 1716, 04-24-09)
C. CPT Modifier “-57” - Decision for Surgery Made Within Global Surgical
C. CPT Modifier “-57” - Decision for Surgery Made Within Global Surgical Period
Carriers pay for an evaluation and management service on the day of or on the day before a procedure with a 90-day global surgical period if the physician uses CPT modifier “-57” to indicate that the service resulted in the decision to perform the procedure. Carriers may not pay for an evaluation and management service billed with the CPT modifier “-57” if it was provided on the day of or the day before a procedure with a 0 or 10-day global surgical period.
Here is the link to the manual in its entirety http://www.cms.hhs.gov/manuals/Downloads/clm104c12.pdf
I thank you in advance for your time and reply.
CMS Physician Manual (Rev. 1716, 04-24-09)
C. CPT Modifier “-57” - Decision for Surgery Made Within Global Surgical
C. CPT Modifier “-57” - Decision for Surgery Made Within Global Surgical Period
Carriers pay for an evaluation and management service on the day of or on the day before a procedure with a 90-day global surgical period if the physician uses CPT modifier “-57” to indicate that the service resulted in the decision to perform the procedure. Carriers may not pay for an evaluation and management service billed with the CPT modifier “-57” if it was provided on the day of or the day before a procedure with a 0 or 10-day global surgical period.
Here is the link to the manual in its entirety http://www.cms.hhs.gov/manuals/Downloads/clm104c12.pdf
I thank you in advance for your time and reply.