tci E/M Coding Alert - 2015 Issue 7

Reader Questions: Check the Dates Before Adding 57

Question: A patient had an office visit (99213) with a 185 diagnosis on Feb. 17. The next day, Feb. 18, my doctor did an inpatient procedure (55866), which has a 90-day global period, with the same diagnosis. Medicare denied the office visit as being part of the global period. Can we resubmit with modifier 57? California Subscriber Answer: If your urologist did indeed make the decision for surgery on Feb. 17, the day before a laparoscopic retropubic robotic assisted radical prostatectomy (55866, Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed) then using modifier 57...

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