Orthopedic Coding Alert

Question: My physician is adding modifier 57 to all E/M visits in which he makes the decision for surgery, even when surgery is a week or more away. Is this correct?


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Answer: No. You should not append modifier 57 (Decision for surgery) to an E/M service that the surgeon performs before the global preoperative period begins. You should only append modifier 57 to an E/M code (such as 99212-99215, Office or other outpatient visit for the E/M of an established patient ...) if the surgeon performs the E/M the day of or day before major surgery, and if the surgeon makes the decision for surgery during that E/M visit.

You do not need to append modifier 57 to an E/M service that the surgeon performs outside of the global period, such as a week before surgery.