Wiki Use of 57 modifier

[mmelcam]

I just wanted to throw this out there to see if anyone has been told this before. Someone at Aetna told our A/R person that we need to append a modifier 57 on an initial consultation if it is done up to 10 days prior to a major (90 day global) surgery. Example: We do an initial consultation on 9/23/09 and decide that surgery is necessary and so we schedule the surgery. The surgery is scheduled for 9/30/09. The surgery is performed on 9/30/09. They are saying that we should append a modifier 57 on the consultation code from 9/23/09. I have never heard of this before. It has always been my understanding that the 90 day global only includes 1 day prior to the surgery. Has anyone else ever heard of this 10 days prior?

 

[LLovett]

No I haven't but Aenta has a lot of very strict and specific rules. I would ask them for their policy on this in writing. If they say the global period starts 10 days prior to surgery it should be documented and they should be able to provide you with that.

Good luck,

Laura, CPC, CEMC

 

[mitchellde]

Laura is correct, different payers, and even some states have state statutes on this, can designate what the preop timeframe is.. I have experienced this many times for 10 days or 7 days and even up to 14 days prior to the surgery.