Wiki Modifier 57 - perform hip arthroplasty

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ammontagano

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Patient seen March 9th, decision made to perform hip arthroplasty on March 28th
Patient seen by same doctor March 27th for unrelated issue (infected toe)
March 27th claim denies as DAI
Medicare will not accept modifier -24 and tells us that we need to append modifier -57 to office visit from March 27th. We appealed the claim using modifier -24 and the appeal was not accepted by Medicare
We feel this is incorrect as the decision for surgery was made 3/9 and this visit was unrelated.
Is it us or is Medicare correct? Any replies would be appreciated.
 
A modifier -24 wouldn't be correct because that modifier specifically says "unrelated E/M service by the same physician during a
postoperative period. Since the surgery hadn't been performed yet the -24 modifier wouldn't apply here.
 
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but the -57 isnt correct either because there was no decision for surgery that day, and it wasn't related either. 25 wouldnt be correct because it's no same day. I know the modifier says "postoperative" but might there be something elsewhere that would allow 24 during the global in general? because 90 day globals also have a 1 day pre-op period. Maybe something in the CPT Assistant? I dont have one otherwise I would look. Anybody else have thoughts on this?
 
I agree that -57 isn't appropriate either so I don't really know the answer to the question other than to say -24 isn't right either! As for the -24 modifier...I pulled this from the medicare website -24 Use on an unrelated E/M service beginning the day after a procedure, when the E/M is performed by the same physician* during the 10 or 90 day post-operative period. . I'm with Aaron...anyone have a solution?
 
Unfortunalty there does not appear to be a proper modifier for this situation. At best you may have to appeal with the notes. At worst it will not be deemed payable due to the surgery the following day on a different site.

Sorry, could not find anything more helpful.
 
Would a modifier even be needed at all? If the 3/27 was for a completely different diagnosis than the initial visit and obviously different than the need for surgery, wouldn't an e/m with no modifier work?
 
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