Wiki 57 mod on everything!?

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Lynda Wetter

Lynda Wetter

True Blue
Local Chapter Officer
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Glen Allen, VA
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Just curious to the different responses on this one.

What are your opinions on someone that puts a 57 modifier on 95% of all the office visits done.
Weather a procedure was done or not and global days or not. Just blanketing the 57......?
 
That is incorrect billing, the modifer is only to be used if a procedure is being within 24 hours of the visit. It could border on fraud.
 
I agree - what could possibly be their reasoning for using the -57 modifier on all office visits? The modifier specifically states Decision for Surgery so unless your docs are taking 95% of their patients to the OR within 24 hours of the E/M there is no reason to use the modifier.
 
what if the surgery and e&m done same day and the surgery codes are a combination of 10 day and 90 day codes. which modifier is used for the e&m?

For example for a dermatology visit that resulted in surgery same day.
some of the surgery cpt's are minor and major cpts? 25 vs. 57 - most payers consider the e&m incidental to the surgery, but dr wants to bill the e&m service because they feel that the exam was necessary to decide what to do
 
The 57 is very specific in that it is for a visit that results in a decision to do the surgery, if the surgery has already been determined prior to this encounter then the 57 is inappropriate. The 57 modifier is used for major procedures (those with more than 10 days in the post op global) on the same day or within a reasonable time. The 25 is used for a significant procedure (those with 10 or less days in the global) on the same day as the evaluation to determine the need for the procedure. An E&M on the same day as a procedure either major or minor when the procedure is prior planned is incidental and is considered non billable.
 
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