Modifier Coding Alert

Published on Fri Feb 20, 2015 PDF

Question: During a routine visit on Monday, the physician made the decision to perform surgery later that day due to elevated blood pressure and heart rate. The lab tests found inflammation of the patient’s liver so the surgery had to be postponed until Friday. Can I use modifier 57 on the surgery procedure code?

Florida Subscriber

Answer: Since your surgeon postponed the surgery until four days later, there is no need for modifier 57 (Decision for surgery). The E/M service was not on the same day or the day before the surgery, the payer will not bundle it with the surgical global period.

Good news: If you submit the first visit with modifier 57 prior to knowing the surgeon would postpone the surgery, it will not prevent payment of the routine visit or the surgery.

In order for you to use modifier 57, the surgeon would have to perform the surgery on the same day or the day after the decision for surgery. You would then attach the modifier on the E/M code you report for the office visit, not the surgical code.