tci Part B Insider - 2004 Issue 20

MODIFIERS: Don't Throw Away E/M Reimbursement On Last-Minute Decisions

Follow these guidelines to get paid for -57 modifier Surgeons are throwing away reimbursement for evaluation and management services, where they see a patient on a consultation and decide to perform surgery immediately. They can bill for those visits using the -57 modifier (decision to perform surgery) but seldom do so, according to consultant Robyn Lee with Lee-Brooks Consulting in Chicago. This frequently happens in the hospital setting, according to Lee. "They won't bill for the consult because they don't realize they can, and it's all documented in the medical record," she says. But billing for an E/M...

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