tci General Surgery Coding Alert - 2000 Issue 6

Reader Question: Appeal Modifier -57 Denials

Question: Recently, Ive noticed more and more insurance carriers either denying or bundling the procedures with modifier -57 attached. Our office uses a hospital admit procedure code (99221-99223) or consultation code (99241-99245 or 99251-99255) with modifier -57. Some insurance companies bundle the two codes and pay only for the surgery. For example, we would bill 99244-57 and 49505 (repair, initial inguinal hernia, age 5 years or over; reducible). The explanation of benefits (EOB) will come back as 56341 (now 47563, cholecystectomy with cholangiography) with a message that the services were bundled together, and the evaluation and management (E/M) is...

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