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Otolaryngology Coding Alert

Reader Questions:

Use Modifier -57 Exclusively on E/M Codes

Published on Sat Jan 01, 2005

Question: May I append modifier -57 to a surgical code as you suggest in the November 2004 Otolaryngology Coding Alert?

New York Subscriber Answer: No, you should use modifier -57 (Decision for surgery) only on E/M services, not procedures. In Appendix A - Modifiers, CPT specifically states that you should add modifier -57 "to the appropriate level of E/M service."
 
It makes sense that you would append modifier -57 only to E/M codes. The modifier tells the payer that the E/M service resulted in the initial decision to perform the surgery.
 
The article "Sometimes, You Should Bill a Pre-Op Visit" should have recommended that you append modifier -57 to 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient), instead of to 42305 (Drainage of abscess; parotid, complicated). The otolaryngologist made the decision for surgery after performing the hospital visit (99231-99233).


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