Wiki Modifer -57 help, New to Ortho

[Snflwr]

What is the correct use for -57, if doctor sees pt in office and decides to do surgery that day must I use -57, or if doctor sees pt but states in note that surgery will be the following day do I still use it. Thanks for any suggestions

 

[Lisa Bledsoe]

Modifier -57 is used on the E/M for the day of or the day prior to surgery, to indicate the decision for surgery was made at that encounter.

 

[Snflwr]

So, if the doc indicates in dictation that surgery is to be performed that day or the next I should always use -57?

 

[Lisa Bledsoe]

Yes, for the E/M code; and as long as the planned procedure has a 90 day global period (most ortho procedures do).

 

[Snflwr]

The phsyician will still get paid for the E/M code though, correct?

 

[Bella Cullen]

Yes, the dr will get paid for the OV.
Also, say dr did a OV on the day before sx and the day of sx, then the OV on the day before gets billed with the 57 mod and the day of sx is not billable.
Hope I didn't confuse you.

 

[Lisa Bledsoe]

Yes the doctor should get paid. You might have to appeal as some insurances are starting to deny -57 the first time around.

 

[Snflwr]

Thanks everyone for your help! A little rusty on surgery coding, it has been a while! Thanks again!