Wiki Modifer 57

[LStana]

Is modifier 57 only to be used if the major surgery is done the same day or the following day of the decision for surgery? I thought we only used it in this situation, but I am being told that we can use it no matter when the surgery is. Any help is appreciated. Thank you.

 

[dclark7]

This modifier is only to be used if the decision for surgery is made the same day or the day before.

The CPT Global Surgical Package Definition under Surgery Guidelines state that "....in a given CPT surgical code, the following services are always included in addition to the operation per se:" The second item it lists is "Subsequent to the decision for surgery, one related E/M encounter on the date immediately prior to or on the date of procedure (including history and physical)."

Modifier 57 tells the insurance company that this was the intial decision for surgery so the E/M should be paid separately.

 

[LStana]

Thank you for the clarification