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General Surgery Coding Alert

Reader questions:

Choose 25 or 57 With These Guidelines

Published on Wed Mar 10, 2010

Question: I'm confused about the distinction between modifiers 25 and 57. Could you please explain the difference? Ohio Subscriber Answer: You might use either modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) or modifier 57 (Decision for surgery) when your surgeon performs a procedure and a distinct E/M service for the same patient on the same day. The quickest distinction is that you would use 25 for a distinct E/M with a minor procedure, and 57 for a distinct E/M with a major follow-up procedure. Read on for a more nuanced description of how you should use the two modifiers. Do this for 25: Your modifier 25 claims should meet all of the following criteria: The E/M occurs on the same day as the surgical procedure The procedure following the E/M is minor (has a [...]
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