-57 is to be used only for major procedures, only for the purpose of deciding to do the procedure on the day of the E&M visit. Here's the CCI edit for major procedures:
If a procedure has a global period of 090 days, it is defined as a major surgical procedure. If an E&M is performed on the same date of service as a major surgical procedure for the purpose of deciding whether to perform this surgical procedure, the E&M service is separately reportable with modifier 57. Other [FONT=Courier New,Courier New][FONT=Courier New,Courier New]preoperative [/FONT][/FONT]E&M services on the same date of service as a major surgical procedure are included in the global payment for the procedure and are not separately reportable. NCCI does not contain edits based on this rule because Medicare Carriers (A/B MACs processing practitioner service claims) have separate edits.
Note that your carrier may have specific edits not addressed in CCI.
Also per CCI edits, an E&M on the same day is bundled into a minor procedure:
If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. [FONT=Courier New,Courier New][FONT=Courier New,Courier New]E&M services on the same date of service as the minor surgical procedure are included in [/FONT][/FONT][FONT=Courier New,Courier New][FONT=Courier New,Courier New]the payment for the procedure. [/FONT][/FONT]The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an
E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.
We've found that even if additional work with a different diagnosis is done with the minor procedure, and even with adding the -25, we rarely get paid.
