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Modifier 57 Remains Handy Post Removal of Consult Codes

Published on Fri May 27, 2011

Take a hint from a CPT®'s global period when choosing between modifiers 25 or 57.Contrary to popular thinking, modifier 57 does not apply exclusively for consultation codes only. Medicare may have stopped paying for consult codes, but this doesn't mean you have to stop using modifier 57. Here are two tips on how you can use this modifier to suit your practice's needs.Background: Starting January 1, 2010, the Centers for Medicare and Medicaid Services (CMS) eliminated consult codes from the Medicare fee schedule.Non-Consult Inpatient Codes Keep Modifier 57 AliveWith CMS eliminated consult codes (99241-99245, 99251- 99255) for Medicare patients, you might have wondered if modifier 57 (Decision for surgery) would remain useful. The answer? You can still use this modifier for a non-consult inpatient E/M code, so long as your documentation supports it.This is because any major procedure includes E/M services the day before and the day of the procedure [...]
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