Cardiology Coding Alert

Question: If the cardiologist admits a patient and inserts an automatic internal cardioverter defibrillator (AICD) the same day, should I bill both services using modifier 57 on the E/M code?


California Subscriber
  Answer: You can use modifier 57 (Decision for surgery) only if your cardiologist made the decision to insert the AICD on the same day as the admission.

Best advice: Check your global period for the AICD. This is what drives the correct modifier for the E/M service provided.

In other words, if the procedure has a zero- or 10-day global period, you'll use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the E/M code if it was significant and separately identifiable from the procedure (such as when the cardiologist renders a full E/M service on the same day he makes the decision to perform the procedure). If the procedure has a 90-day global, then you'll use modifier 57.

To use modifier 57 properly, you must remember these points:

• The E/M service occurs the day of or the day before a major surgical procedure (a procedure with a 90-day global period). • The E/M service must prompt the surgical procedure that follows. • The E/M service must be related to the procedure that follows. • The same physician provides the E/M service and the surgical procedure.   You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.