Global Surgery Modifiers

 Modifier 57 E/M services furnished by the surgeon on the day before or on the day of major surgery, that result in the initial decision to perform the surgery, may be covered separately from the surgery. The E/M service should include modifier 57.

Modifier 25 E/M services furnished on the same day as a minor surgical procedure may be covered separately only if the patient ’ s condition required a significant, separately identifiable E/M service above and beyond the usual pre- and postoperative care associated with the procedure. The E/M service should include modifier 25.
Note: When utilizing modifier 25, the medical record must clearly reflect why the visit was unrelated to the surgical procedure.

Modifier 24 Unrelated E/M services furnished by the same physician in the postoperative period of a major surgical procedure may be covered. The E/M service should include modifier 24. Note : When utilizing modifier 24, the medical record must clearly reflect why the visit was unrelated to the surgical procedure.

Modifier 58 Modifier 58 supports the billing of staged or related surgical procedures performed during the post- operative period of the first procedure. Modifier 58 is not used to report the treatment of a problem that requires a return to the operating room. It may be necessary for the physician to add modifier 58 to a surgical procedure performed during the postoperative period if it:

* Was planned prospectively or at the time of the original procedure;
* Was more extensive than the original procedure; or
* Is used for therapy following a diagnostic surgical procedure. A new postoperative period begins when the next procedure in the series is billed.

Modifier 78 When treatment for complications requires a return trip to the operating room, separate payment may be made for the procedure (whether it is the same or a different procedure). The procedure should include modifier 78.

Modifier 79 Separate payment may be made when a surgical procedure furnished during the postoperative period is unrelated to the previous procedure. The procedure should include modifier 79. A new postoperative period begins when the unrelated procedure is billed.

Note : When utilizing modifier 79, the medical record must clearly reflect why the surgery was unrelated to the previous surgical procedure.

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