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Ophthalmology and Optometry Coding Alert

Modifier 25 or 57? Use This Handy Tool to Pick the Right Modifier -- Every Time

Published on Wed Oct 27, 2010

Your modifier 25 claims should meet all of the following criteria:The E/M occurs on the same day as the surgical procedureThe procedure following the E/M is minor (has a zero or 10-day global period)The E/M service is both significant and separately identifiable from any inherent pre-operative E/M component that the procedure requiresThe same physician (or one with the same tax ID) provides the E/M service and the surgical procedure.Note that the diagnosis associated with the E/M service can be the same as the diagnosis associated with the sameday procedure, which means that the E/M prompted the subsequent procedure. Or, the diagnosis associated with the E/ M service can be different than the diagnosis associated with the same-day procedure, meaning that the E/M may be for a significant problem unrelated to the procedure.Use modifier 57 if the claim meets all of the following criteria:The E/M occurs on the same day of [...]
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