General Surgery Coding Alert - 2014 Issue 11
Denial Management: Know Appropriate Use of Modifier 57
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Article Overview
This article reviews denial-management considerations for modifier 57 in the context of payer global-period definitions and claims-editing behavior. It is aimed at coders, billers, compliance staff, and revenue cycle teams who need to understand why claims may be rejected and how payer policy differences can affect billing workflow. The discussion covers Medicare and CPT/CMS framing, differences among payers, and practical steps for responding to repeated denials.
Why This Topic Matters
Modifier 57 denials can lead to lost reimbursement, unnecessary appeals, and billing errors if payer rules and software limitations are not understood. Knowing the relevant global-period policies helps organizations reduce avoidable denials and manage claims more efficiently.
Article Sections
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Know Your Payer’s Definition of a Global Period
Explains that payers may define global surgical packages differently and discusses the importance of understanding payer-specific policies. It also references Medicare, CPT, and general categories of global periods.
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Be Aware of Possible Problems with Payer’s Claims-Editing Software
Describes how claims-editing systems can contribute to denials when a service and procedure are processed together. It also outlines general troubleshooting and communication considerations with payers.
What You Will Learn
- How payer definitions of global periods can differ
- Why claims-editing systems may contribute to denials
- General approaches to handling repeated payer denials
- Why internal payer reference tracking can be useful
Who Should Read This
- Medical coders
- Billing staff
- Compliance teams
- Revenue cycle managers
- Physician practice administrators
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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