Neurology & Pain Management Coding Alert

Question: What separates or determines the choice of modifiers 25 or 57?

Maryland Subscriber

Answer: Study the procedure's global days to figure out whether you must append 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 57 (Decision for surgery) to the E/M code.

Use modifier 25: When your physician provides a significant and separately identifiable E/M on the same day as a minor procedure (meaning one with a 0- or 10-day global period), modifier 25 is appropriate.

Use modifier 57: If your physician provides an E/M service on the day before or on the day of a major surgery -- meaning one with a 90-day global period -- that results in the initial decision to perform the surgery, append modifier 57.