ED Coding & Reimbursement Alert - 2004 Issue 11
Reader Questions: Forgo -57 for Patients Headed Directly to OR
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Article Overview
This reader Q&A addresses when modifier -57 may be considered in connection with a surgeon’s evaluation and a decision for surgery, with emphasis on how Medicare-style global period rules affect reporting. It also touches on related evaluation and management reporting concepts, laceration repair services, and where to verify global period information through CMS resources. The article is useful for coders, billers, and compliance staff working with surgery-related professional claims.
Why This Topic Matters
Accurate use of surgery-related modifiers and global period rules affects whether related services are reported separately and can influence claim compliance. The article helps readers understand the general boundaries between evaluation and management services and procedure reporting in a common real-world scenario.
Article Sections
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Question
Introduces the coding scenario and the reader’s questions about modifier use in relation to surgery and repair services.
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Answer
Provides general guidance on modifier use, global period considerations, and the relationship between evaluation and management services and procedural reporting.
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Tip
Points readers to a CMS resource for checking global periods for individual procedures.
What You Will Learn
- How the article frames modifier use in relation to a decision for surgery
- How global period concepts are discussed in connection with procedural reporting
- How the article connects separate evaluation and management services with procedure billing
- Where the article directs readers to look up procedure-specific global period information
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Compliance staff
- Physician practice managers
Codes Discussed
Modifiers Discussed
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