tci General Surgery Coding Alert - 2004 Issue 11

Reader Questions: Forgo -57 for Patients Headed Directly to OR

Question: When should I use modifier -57 (Decision for surgery)? Does this modifier apply to patients admitted to the hospital who go directly to the operating room? Does it apply to patients who receive laceration repair, for instance?Kansas Subscriber Answer: You should append modifier -57 when the E/M service the surgeon performed resulted in the decision for surgery - for example, a surgeon's examination of a patient reveals an immediate need for surgical intervention. However, for Medicare and payers that follow Medicare rules, you should only append modifier -57 to procedure codes that have 90-day postoperative periods...

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