tci Medicare Compliance & Reimbursement - 2014 Issue 11

Denial Management: Know Appropriate Use of Modifier 57

Variations in global period definitions spell trouble for you. Use modifier 57 (Decision for surgery) incorrectly and you could find yourself in hot water. Read on to see how variations in global period definitions and claims edits could lead to denial of your claims, and which steps can help you avoid those problems. Know Your Payer’s Definition of a Global Period One potential cause of modifier 57 denials is that payers may have different definitions of a global period. The Centers for Medicare and Medicaid Services (CMS) defines a global surgical package as “all necessary services normally...

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