Modifier 57

We have noticed (with various payers, even Medicare) more often lately that claims with modifier 57 on the E & M code are denying when we are billing a 90 day global procedure code, indicating that payment for preoperative care is included in allowance for surgical care. Are you aware of any recent changes regarding this, as it seems like it wasn't an issue in the past. Thanks.

re: Modifier 57

I have heard this about private payers, but not about a Medicare contractor.

For the private payers, it is a contracting issue to bring up with them. You might have your physician write or call the medical director if it is a local plan. I would keep track of the volume and dollars.

For Medicare, you might want to call your regional CMS office. I would also call my specialty society: all of them have advocacy and insurance staff.

re: Modifier 57

Thank you for your help.