perkins05
Expert
Does medicare require mod 57 on e/m day before surgery even if the surgery is minor in nature (I&D)? All help is appreciated.
Thanks
Thanks
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki modifier 57 -medicare require
- Thread starter perkins05
- Start date
DROMERO
New
The way we bill it is if the surgery is on the day before the E/M you would bill a 57 and if the surgery is on the same day of the minor surgery it would be mod 25 on the E/M for Medicare.
arleneg65
New
Actually, on the Medicare website it states that if a surgery has a 10 day or less global, use mod 25, and 11-90 day global use 57.
this is the link to a flowchart per the Medicare website.
http://www.pinnaclemedicare.com/provider/partb/education/dataanalysis/modflow/mod57.pdf
this is the link to a flowchart per the Medicare website.
http://www.pinnaclemedicare.com/provider/partb/education/dataanalysis/modflow/mod57.pdf
Last edited:
RebeccaWoodward*
True Blue
Modifier 57 is for major surgeries.
4. Evaluation and Management Service Resulting in the Initial Decision to Perform Surgery
Evaluation and management services on the day before major surgery or on the day of major surgery that result in the initial decision to perform the surgery are not included in the global surgery payment for the major surgery and, therefore, may be billed and paid separately.
In addition to the CPT evaluation and management code, modifier “-57” (decision for surgery) is used to identify a visit which results in the initial decision to perform surgery. (Modifier “-QI” was used for dates of service prior to January 1, 1994.)
If evaluation and management services occur on the day of surgery, the physician bills using modifier “-57,” not “-25.” The “-57” modifier is not used with minor surgeries because the global period for minor surgeries does not include the day prior to the surgery. Moreover, where the decision to perform the minor procedure is typically done immediately before the service, it is considered a routine preoperative service and a visit or consultation is not billed in addition to the procedure.
http://www.cms.gov/manuals/downloads/clm104c12.pdf
Page 96
4. Evaluation and Management Service Resulting in the Initial Decision to Perform Surgery
Evaluation and management services on the day before major surgery or on the day of major surgery that result in the initial decision to perform the surgery are not included in the global surgery payment for the major surgery and, therefore, may be billed and paid separately.
In addition to the CPT evaluation and management code, modifier “-57” (decision for surgery) is used to identify a visit which results in the initial decision to perform surgery. (Modifier “-QI” was used for dates of service prior to January 1, 1994.)
If evaluation and management services occur on the day of surgery, the physician bills using modifier “-57,” not “-25.” The “-57” modifier is not used with minor surgeries because the global period for minor surgeries does not include the day prior to the surgery. Moreover, where the decision to perform the minor procedure is typically done immediately before the service, it is considered a routine preoperative service and a visit or consultation is not billed in addition to the procedure.
http://www.cms.gov/manuals/downloads/clm104c12.pdf
Page 96
perkins05
Expert
Thanks Ladies....