tci Part B Insider - 2012 Issue 18

Modifiers: Refresh Your Modifier 57 Knowledge to Keep Reimbursement Flowing

Hint: Avoid using 57 for minor procedures.In these tough economic times, every dollar counts--and if you're not applying modifier 57 (Decision for surgery) when your physician performs an E/M visit prior to the decision for surgery, you could be leaving ethical reimbursement on the table. Reserve 57 for Major SurgeriesYou should only report modifier 57 when the doctor decides to treat a condition surgically on the day before or the day of a 90-day global period procedure per Medicare guidelines. The documentation must support that the decision for surgery was made on that date and it was not...

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