ED Coding & Reimbursement Alert - 2011 Issue 22
Reader Question: Avoid Modifier 57 When Surgery Was Planned in Advance
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Article Overview
This reader question explores how to code inpatient evaluation and management services when a planned operative procedure is postponed because a patient’s other condition must be stabilized first. It is relevant to professional coders and billing staff who work with hospital E/M reporting, surgery-related modifier use, and preoperative care scenarios. The article discusses the general handling of the admission and subsequent care, and it clarifies why certain modifiers are not appropriate in this situation.
Why This Topic Matters
Preoperative delays can create uncertainty about whether hospital care should be reported separately and which modifiers are appropriate. Understanding the article helps coding staff avoid inappropriate modifier use on E/M and surgical claims in a common real-world scenario.
What You Will Learn
- How to think about hospital admission and follow-up care when surgery is postponed for medical stabilization
- How the article frames modifier use in relation to E/M and surgery-related services
- How planned procedures and postoperative-period modifiers are discussed in a preoperative delay scenario
- How the article addresses reporting decisions for inpatient care before surgery
Who Should Read This
- Medical coders
- Billing specialists
- Revenue cycle staff
- Physician practice coders
- Hospital outpatient and inpatient coding staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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