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tci General Surgery Coding Alert - 2003 Issue 9

Reader Question: Use -57 for Admission and Same-Day Procedure

Question: May I report a hospital admission and procedure on the same day? My payer has been rejecting the admission as not separately reimbursable. Nevada SubscriberAnswer: Yes, you may bill an E/M service, such as a hospital admission (99221-99223), for the same date of service as a procedure under the appropriate conditions, and if you append modifier -57 (Decision for surgery) to the E/M service code. The global surgical period for major surgeries under the Medicare fee schedule begins one day prior to the procedure itself, and includes one preprocedure E/M service for patient evaluation. For this reason, payers...

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