tci ED Coding & Reimbursement Alert - 2019 Issue 2

Modifiers: RACs Boost Scrutiny of Modifier 57

From fractures to other services, you probably use this modifier now and then – find out what’s under review. If your ED is like most, you probably use modifier 57 (Decision for surgery) from time to time, often when treating fractures. The modifier may seem straightforward, but many practitioners are assigning it incorrectly – leading to its recent addition on the Recovery Audit Contractors’ (RACs) list of open issues. Background:  RACs review Medicare claims for errors and collect a contingency fee based on the amount they recover. Much like MACs, there are different RAC contractors for the...

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