Cardiology Coding Alert

Question: When should I use modifier -57? I know the modifier definition is "decision for surgery," but can I use it when the cardiologist made the decision during an admission or consult in the hospital to proceed with cardiac cath/intervention or peripheral angio/intervention?

Wisconsin Subscriber

Answer: You should use modifier -57 only when the cardiologist made the decision to perform major surgery (in other words, those having a 90-day global period).

Note: When a cardiologist provides an E/M service on the same day as a minor surgical procedure (in other words, those having fewer than 90 global days) and it is appropriate, you should report the E/M with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) instead. This includes those surgical procedures with "0" global days. Keep in mind that "0" global days is not the same as "no global period" or "global period does not apply."

Because the cardiac catheterization (such as, 93510), peripheral angiography (such as, 75630), and peripheral interventions (such as, 37205) you mentioned do not have 90 global days, you should use modifier -25 instead. You would apply this modifier to the admission (99221-99223) or consult code (99241-99255). 

- 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.