Neurosurgery Coding Alert

Remember that the global period begins 1 day prior to surgery When an E/M service prompts a -major- surgical service, you should append modifier 57, rather than modifier 25, to gain separate payment for the E/M service. Follow our checklist to apply modifier 57 correctly and avoid the 25/57 confusion. Look for a 90-day Global You should apply modifier 57 (Decision for surgery) only when an E/M service precedes a surgical procedure with a 90-day global period. Medicare restricts modifier 57 to major surgeries, and the Medicare Internet Only Manual (IOM), section 40.2, specifically instructs carriers not to pay -for an evaluation and management service billed with the CPT modifier 57 if it was provided on or the day before a procedure with a zero- or 10-day global surgical period.- In neurosurgery practice, many of the most common procedures, such as laminectomies, arthrodesis and instrumentation placement, are -major surgical procedures- with 90-day global periods. For a significant and separately identifiable E/M service that occurs on the same day as a minor procedure (any procedure with a zero- or 10-day global period), you should append modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) rather than modifier 57, says Suzan Hvizdash, BS, CPC, CPC-EMS, CPC-EDS, physician educator for the department of surgery at the University of Pittsburgh Medical Center. Minor procedures include spinal taps (62270), many types of injections (such as trigger point injections 20552 and 20553), vertebroplasty (22520-22522) and kyphoplasty (22523-22525). Tip: For more information on global periods, see -Global Periods Made Easy- in this issue.
The E/M Must Prompt the Surgery You may append modifier 57 only if the E/M service preceding the surgery directly led to or prompted the decision for surgery. In such a case, the surgeon would see the patient for an E/M service and schedule the surgery for either the same or the next day. Direct from CMS: The IOM, section 40.2, directs carriers, -Pay for an E/M service on the day of or on the day before a procedure with a 90-day global surgical period if the physician uses CPT modifier 57 to indicate that the service was for the decision to perform the procedure.- Warning: If the physician has already scheduled surgery and then provides a final E/M service prior to surgery, you cannot charge separately for the service. Example: The surgeon schedules laminectomy (for example, 63047) for a patient with spinal stenosis (724.02). A week later on the day before surgery, the surgeon meets with the patient for a final evaluation, to answer any questions the patient has and to provide additional instructions for recovery. In this case, you cannot [...]