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tci E/M Coding Alert - 2014 Issue 3

Mind Your Modifiers: Save Time By Understanding When to Use Modifier 57

Knowing why a claim with modifier 57 is denied, may help your appeal.  Modifier 57 is under heavy scrutiny from payers, including Medicare. If you aren’t using this modifier correctly, your practice may face denials or owe money back to your payers at audit time. Review two common culprits behind modifier 57 (Decision for surgery) denials and learn what you can do to avoid them.    Know Your Payer’s Definition of a Global Period  Because some payers have a different definition of a global period than CMS, they may deny a claim with modifier...

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