Forum - Questions & Answers

Feb 18th, 2014 - nregan 1 

Need correct modifier

Our surgeon saw a patient in the office (99244) and made a decision for surgery. He took the patient to the operating room (at hospital) later that day (port placement, 10 day global period, 36561). When I billed the office visit, I billed it with modifier 57 which I now realize can only be used with a 90 day global period.

Can I resubmit the office visit with a different modifier or is the 99244 really bundled with the 36561? Again, the doctor saw the patient in the office, made a decision for surgery and then went to the hospital later in the day for the surgery. MAC anesthesia was used. Thank you!

Feb 18th, 2014 - cmc2012 14 

re: Need correct modifier

The modifier 57 is not use w minor surgeries because the global period of minor surguries does not include the day prior to the surgery. Where the decision for the minor procedure is tipically done immediately before the service, it's considered a routine pre-operative service and a visit or consultation is not billed in addition to the procedure. (In other words, visit/consult will not get paid, not even w a different modifier because it should not have been billed)

Statement above as per Medicare Claims Manual.... Hope that helps!

Feb 18th, 2014 - nregan 1 

re: Need correct modifier

Thank you very much for the information.



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