tci Part B Insider - 2004 Issue 20

MODIFIERS: Consider Using Time-Based Billing For E/M Visits With Modifier -57

Remember the 50-percent rule and you'll come out ahead. An evaluation and management visit in which the physician makes the decision to go ahead with surgery will involve a lot of medical decision making, but it may be hard to document enough to justify a high-level visit. That's why you should consider billing for these modifier -57 visits using the counseling and coordination care rule instead, says consultant Quinten Buechner with Proactive Consultants in Cumberland, WI. Often, a lot of time is spent in these visits discussing the surgery with the patient, who may need to discuss scary topics...

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