tci Part B Insider - 2010 Issue 21

Reader Questions: Modifier 57 Isn't for Consults Only

Question: In our office we used to apply modifier 57 to inpatient consult codes. Now that Medicare doesn't accept consult codes, how should we use this modifier?Answer: The short answer is that you should append modifier 57 (Decision for surgery) to the non-consult inpatient E/M code that the documentation supports. Suppose an ob-gyn performed a 2009 level-three inpatient consult in which the physician determined the patient required an exploratory laparotomy later that same day due to severe abdominal distention and pain as well as some uterine bleeding. Adding the modifier to the E/M code will help show payers...

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