nyyankees
True Blue
can you report both mod 57 and 25 on same claim?
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Wiki Mod 57 & 25
- Thread starter nyyankees
- Start date
mitchellde
True Blue
I cannot think of any scenarios where you would. What is the one you have.
Amy Pritchett
Guru
Can you be more specific as to the reason for using both or is it just a general question?
Modifier -25 would be used for an in-office procedure or in the Emergency Department if the patient had to have sutures placed, Incision/Drainage and/or Debridement, etc.
The modifier -57 is used when a patient elects on an office visit to have surgery performed. Scenario: The patient presents with severe left side pain and fever. The patient is found to have an appendicitis and the patient decides to have surgery that day.
I cannot think of an episode where both would be used together. Hope this helps you
Modifier -25 would be used for an in-office procedure or in the Emergency Department if the patient had to have sutures placed, Incision/Drainage and/or Debridement, etc.
The modifier -57 is used when a patient elects on an office visit to have surgery performed. Scenario: The patient presents with severe left side pain and fever. The patient is found to have an appendicitis and the patient decides to have surgery that day.
I cannot think of an episode where both would be used together. Hope this helps you
jdibble
True Blue
I don't know of any situation where they would both be needed on the same code - and may cause your claim from not being paid. These modifiers are applied for different circumstances.
The 25 modifier is applied to an E/M code when a separate, minor procedure (global period of 0-10 days) is done on the same date of service. The 57 modifier is applied to an E/M code when that visit results in the physician making the decision to do major surgery (global period of 90 days) on the same day or next day. The E/M can be either outpatient or inpatient for either of these codes - place of service is not an issue.
Hope that helps!
The 25 modifier is applied to an E/M code when a separate, minor procedure (global period of 0-10 days) is done on the same date of service. The 57 modifier is applied to an E/M code when that visit results in the physician making the decision to do major surgery (global period of 90 days) on the same day or next day. The E/M can be either outpatient or inpatient for either of these codes - place of service is not an issue.
Hope that helps!
nyyankees
True Blue
Can you be more specific as to the reason for using both or is it just a general question?
Modifier -25 would be used for an in-office procedure or in the Emergency Department if the patient had to have sutures placed, Incision/Drainage and/or Debridement, etc.
The modifier -57 is used when a patient elects on an office visit to have surgery performed. Scenario: The patient presents with severe left side pain and fever. The patient is found to have an appendicitis and the patient decides to have surgery that day.
I cannot think of an episode where both would be used together. Hope this helps you
general question - just wanted to make sure..Thanks.
Monika Liddle
Expert
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Mod 25/57
I have had to use both mod 25/57 on the same claim. Patient is seen as an initial hospital visit (9922x) and provider makes the decision for surgery. The patient has a partial colectomy with anastomosis and a TLC was placed. The partial colectomy is a 90 day global period and the TLC has a 0 global period.
It does not happen to often, but it can happen.
I have had to use both mod 25/57 on the same claim. Patient is seen as an initial hospital visit (9922x) and provider makes the decision for surgery. The patient has a partial colectomy with anastomosis and a TLC was placed. The partial colectomy is a 90 day global period and the TLC has a 0 global period.
It does not happen to often, but it can happen.
neha.bhatnagar
Networker
Hi,
25 modifier is appended to an E/M code when a minor procedure (global period of 0-10 days) is done on the same day & 57 modifier is appended to an E/M code when the visit results in the physician making the decision to do major surgery (global period of 90 days) on the same day or next day.
You need to choose the correct modifier on basis of whether a minor or a major surgery is preformed along with E&M.
E/M with minor procedure append modifier 25 to E/M.
E/M with major procedure with decision of surgery on same or next day append 57 modifier to E/M.
E/M with both minor procedure & decision for Major surgery on same day or next day, append 25 & 57 both to E/M code.
Hope this helps..!
25 modifier is appended to an E/M code when a minor procedure (global period of 0-10 days) is done on the same day & 57 modifier is appended to an E/M code when the visit results in the physician making the decision to do major surgery (global period of 90 days) on the same day or next day.
You need to choose the correct modifier on basis of whether a minor or a major surgery is preformed along with E&M.
E/M with minor procedure append modifier 25 to E/M.
E/M with major procedure with decision of surgery on same or next day append 57 modifier to E/M.
E/M with both minor procedure & decision for Major surgery on same day or next day, append 25 & 57 both to E/M code.
Hope this helps..!
monica03
Guest
Hi,
25 modifier is appended to an E/M code when a minor procedure (global period of 0-10 days) is done on the same day & 57 modifier is appended to an E/M code when the visit results in the physician making the decision to do major surgery (global period of 90 days) on the same day or next day.
You need to choose the correct modifier on basis of whether a minor or a major surgery is preformed along with E&M.
E/M with minor procedure append modifier 25 to E/M.
E/M with major procedure with decision of surgery on same or next day append 57 modifier to E/M.
E/M with both minor procedure & decision for Major surgery on same day or next day, append 25 & 57 both to E/M code.
Hope this helps..!
That actually helps me a lot. I just had a scenario that called for both. Pt was seen by the doctor and had a minor procedure done that would hold her over until medically cleared for the major procedure that was planned for the next day. Glad to know I can use both modifiers.
BonnieJ123
Networker
mod 57 and 25
E/M same day as heart cath and PPM would warrant both mod 57 and 25.
E/M same day as heart cath and PPM would warrant both mod 57 and 25.