Ophthalmology and Optometry Coding Alert

Question: We use modifier -57 on separately identifiable E/M services during which the decision for surgery is made either on the day before or the day of a surgical procedure. We make sure the service warrants a separate charge, but we still get denied for the claims. Do you have any clue what we could be doing wrong?

Answer: If you're tacking modifier -57 (Decision for surgery) on minor surgical services, that's probably why you're seeing denials for these charges.

Modifier -57 is used for separately identifiable E/M services rendered the day before or day of a major surgical package. Modifier -57 tells the payer, "We know that this preoperative visit is part of the surgical package, but the physician needed a separate, identifiable E/M in order to reach the decision to perform surgery." Usually services requiring that type of E/M visit have 90-day global packages. Minor services do not require that type of E/M visit from a physician.