Wiki modifier 57 -with fracture code

[JLM929]

I need some help regarding Modifier 57. there is some chatter in the office about this. if you come in a office with a new fracture would you put a 57 modifier on the ov with fracture code or modifier 25? when there is no decision for surgery. thanks for any feedback.

 

[mitchellde]

Great question! Technically since fx care has a 90 day global you use the 57 modifier, however some payers see is as a 25 since it is performed in the provider office. I say use the 57 then if the payer denies for modifier resubmit with the 25, I have had more success this way.

 

[MarcusM]

Modifier 57 Fact Sheet

Definition
Indicates an Evaluation and Management (E/M) service resulted in the initial decision to perform surgery either the day before a major surgery (90 day global) or the day of a major surgery.
Appropriate Usage
Append where the decision to perform surgery is made the day of or day before a major surgery during an E/M service
Append only to the E/M procedure code
Inappropriate Usage
Appending to a surgical procedure code
Appending to an E/M procedure code performed the same day as a minor surgery. When the decision to perform a minor procedure is done immediately before the service, it is considered a routine preoperative service and not billable in addition to the procedure.
Do not report for a preplanned or prescheduled surgery, or if the surgical procedure indicates performance in multiple sessions or stages.
Facts
Global period- The day before surgery, the day of the surgery and the number of days following the surgery as indicated on the MPFSDB. Often, a major surgery has a 90 day post operative period and a minor surgery has either a zero or a 10 day post operative period.
A preoperative period is the day before the surgery or the day of surgery.
When an E/M service resulting in the initial decision to perform major surgery is furnished during the post-operative period of another, unrelated procedure, the E/M service must be billed with both the 24 and 57 modifiers.