JUL 19, 2016
Exam Day Before Surgery
Question: Our surgeon performed a corneal transplant the day after an exam. The payer reimbursed the surgery correctly, but denied the exam. Should I code the diagnosis for the exam something different from the procedure, or should I append a modifier?
Answer: You should append modifier -57 Decision for surgery when the physician performs a major procedure the same or next day. For Medicare Part B, major procedures have a 90-day global period. Commercial payers may have a global period of 45, 60 or 90 days. Submit a corrected claim by appending modifier -57 to the exam.