Modifier 56

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September 6, 2018

Question:
Why would we receive a Medicare denial when reporting a major surgical procedure with a modifier 56?
We only did the pre-procedure work and made the decision for surgery.

Answer:
Medicare does not recognize modifier 56 (pre-operative care only); instead report the E&M for the decision for surgery.  Append modifier 57 if the E&M occurs the day of or day before  the major procedure.  The physician performing the surgery or fracture related code will either report the global code or append other appropriate modifiers (e.g. modifier 54 intra-operative care only).

*This response is based on the best information available as of 09/06/18.

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