tci Medicare Compliance & Reimbursement - 2010 Issue 21

Reader Questions: Check If Exceptions Exist in Fracture Modifiers

Question: A parent brings her 14-year-old son to the emergency department with an injured right finger he suffered during a skiing accident. The physician diagnoses a closed metacarpal fracture, which he resets using manipulation and places in a plaster cast. He tells the parent to follow up with an orthopedist for continuing care. Notes indicate a level-three pre-procedure E/M service. What modifier should I append to the E/M code? Answer: Many private payers (and Medicare) want you to append modifier 57 (Decision for surgery) to the E/M service code each time the physician provides definitive fracture care and an...

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