debrooth - Medicare Denial: Visit w/ -57 Modifier
Most of the Medicare's do not recognize modifier 57 on a 0 day global procedure. Most colonoscopies do not have a global period. A few questions...
What E&M code did you use?
If you used a consult code, Medicare will not pay it.
If you used a new patient code, and it is a new patient, add a modifier 25 and resubmit.
If you used an established patient code:
Was it a new or worsening problem that required evaluation beyond what is normally required prior to performing a colonoscopy?
If so, is there documentation to help support the medical necessity of the service? If so, does it support adding an additional
diagnosis code symptom or condition? If so add a modifier 25 and resubmit. A different diagnosis is not required, but if it is documented it is appropriate to add it.
In any of the scenarios, make sure that whatever you do, the documentation will support it. Then fight for all your worth!