subject: Know how to Append Modifier 57 [print this page] Know how to Append Modifier 57 Know how to Append Modifier 57
Medical codes look up
In your coding career, you will often be bowled over by questions such as this.
We used to apply modifier 57 to inpatient consult codes in our ob-gyn office. How should you use this modifier since Medicare does not accept consult codes now?
Well, the answer is that you should go for modifier 57 (Decision for surgery) to the non-consult inpatient E/M code that the documentation supports.
Say for instance the ob-gyn carried out a 2009 level-three inpatient consult in which the ob-gyn determined the patient required an exploratory laparotomy later that same day owing to severe abdominal distention and pain as well as some uterine bleeding. Adding the modifier to the E/M code will help show payers why you are reporting an E/M addition to the major surgery carried out later that day, 49000.
For this year, the exact E/M code you select will depend on the circumstances specific to the visit like whether the visit is the first or second ob-gyn visit during the admission. However, as an instance, say you are coding the ob-gyn's first visit to an inpatient. Your documentation may support 99221, which has requirements similar to 99253.
You should go for modifier 57 to the E/M code. If, however, the ob-gyn is the principal physician, the one overseeing the patient's care and the one who is admitting the patient see to it that you append modifier AI.
For more tips on ways to append modifier 57, sign up for a one-stop medical coding guide. When you do so, you'll have access to a medical codes look up tool, which will help you keep up with all the code changes.
