Usage of Modifier 57

Decision for Surgery: An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding the modifier '-57' to the appropriate level of E/M service.

Usage :

•Use on an E&M service that is related to a major surgery which has a postoperative period of 90 days
•Use on an E&M service when the decision to have surgery was made within 24 hours prior to the surgical procedure

•Do not use modifier -57 for presurgical history and
physical
•Do not use modifier -57 for services related to minor surgical procedures
*Note: Use modifier -25 for E&M services related to a minor surgical procedure; see also -25 modifier guidelines

Example

•A patient presents with acute abdominal pain; an E&M service is performed
•Upon examination, it is determined that the patient has appendicitis and an appendectomy is scheduled for later that day
•Since the appendectomy has a global period of 90 days, the E&M service performed should be appended with modifier -57 indicating a decision for surgery was made
•Coding example: 99215-57, 44950

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