Cardiology Coding Alert

Question: I understand that we should report modifier -57 when a physician decides during the preoperative portion of the 90-day global period to perform a surgical procedure. When we append modifiers to E/M codes, should I make this distinction between procedures of varying global periods, or should I append modifier -57 regardless of global days?

Arizona Subscriber

Answer: Yes, the global days do matter when you append modifiers. According to Medicare rules, you should use modifier -57 (Decision for surgery) to represent the E/M service when the physician makes the initial decision for surgery, as long as the E/M service occurs on the day of or the day before the major surgical procedure. This rule applies to decisions that precede major procedures (defined as a global surgical package of 90 days).

You should append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code when the physician performs a separately identifiable service in addition to a minor procedure (defined as a zero- or 10-day global surgical package). For most cardiology practices, the only major surgical procedures (having a 90-day global) are pacemaker and/or defibrillator implants (for example, 33206-33208, 33212-33213, 33240, 33249).