tci E/M Coding Alert - 2023 Issue Q2

Reader Questions: Beware That Decisions May Not Warrant Own Codes

Question: I billed Medicare for an EGD and a hospital inpatient visit using the 57 modifier to indicate the decision for surgery. The provider examined the patient and then determined they needed the procedure. Medicare denied the claim. What am I doing wrong? AAPC Forum Participant Answer: Medicare probably has an issue with the evaluation and management (E/M) code. The decision for a minor surgery is included in the surgical package. The decision to do the surgery does not, by itself, warrant a separate E/M service. For example, coding 99223 (Initial hospital inpatient or observation care, per day, for...

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