Modifier 25 vs. Modifier 57

cs7@appanet.com

I have a doctor who saw a patient and did same day surgery. The surgery codes are 24685, 11012, 14655. I used a 57 modifier but medicare rejected for that modifier. The medicare rep (who fell asleep while on the phone with me) said it is an incorrect modifier because one of the codes holds a 10 day global period. Is the 25 modifier more appropriate?

cs7@appanet.com

oops it is 24655.

Unknown

Was it done in a surgical setting or office??

Sincerely,

Marla

cs7@appanet.com

Inpatient setting. Used cpt code 99223

jessica-kniess@ouhsc.edu

I think the rep you spoke to is wrong and that they denied your claim inappropriately. Both 24685 and 24655 have 90 day global periods. 11012 has no global period. You may not get paid for the office visit same day since there was surgery also. I often run into this.
Was it actually a clinic visit or was the patient seen in the hospital as an inpatient or outpatient? Was this a new patient to the provider/ provider group?

cs7@appanet.com

My cpt codes have both 90 day global periods and 10 day. They are denying the 57 modifier. Should I use both 25 and 57? And, what would be the sequence?

cs7@appanet.com

She was a new patient to the practice and seen for the first time as an inpatient. This is the first 99223 I have ever had deny along w/same day surgery. The rep did fall asleep while on the phone with me.....

jessica-kniess@ouhsc.edu

I would try both, listed in ascending order, so 25, then 57. The 57 is essential. I'm really not sure why they also want the 25. That seems redundant, but I know carriers often operate in their own convoluted little world sometimes.