Primary Care Coding Alert

Question: If a provider makes a decision to perform cerumen removal using 69209, can I use modifier 57 on the associated evaluation and management (E/M) service, or is modifier 25 more appropriate?

Alaska Subscriber

Answer: You would add a modifier to 99201-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …) if you provider decides to, and then actually does, perform, 69209 (Removal impacted cerumen using irrigation/lavage, unilateral) on the same day.

However, modifier 57 (Decision for surgery) would not be the appropriate modifier to use in this case. Generally, modifier 57 is assigned to major procedures or surgeries, which typically have a global period of 90 days.

Code 69209 has a global period of zero days, indicating it’s generally understood to be a minor procedure. This means that modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) is more appropriately appended to the E/M in this particular situation.