Cardiology Coding Alert
Verify Global for Modifier 57 Use
Question: When should I use modifier 57 on an E/M code?
The modifier applies when the E/M is performed to determine whether the procedure needs to be performed and when the E/M is distinct from the usual pre-work performed for a procedure.
Helpful: Services with 0 or 10 day global periods (minor procedures) include payment for the decision to perform surgery, so you should not report a separate E/M for that process. If the patient does have a separately reportable E/M on the date of the minor procedure, append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service). You also may append 25 to a distinct E/M performed on the same date as an XXX global service.
Resource: You’ll find these rules in Chapter I.D of the CCI manual, which is available online at www.cms.gov/NationalCorrectCodInitEd/.
California Subscriber
Answer: Payer rules may vary, but for those following Medicare rules, append modifier 57 (Decision for surgery) to an E/M code when you report the E/M on the same date as a major surgical procedure. A major surgical procedure is one with 90 global days.
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