Wiki 25 and/or 57 modifiers

[rykin7609]

Question was brought up and we need clarification on these modifiers.

When a surgery AND a procedure are both done on the DOS or day before we would only need to append the modifier 57 to the E/M or H&P......or, do we nee dthe 57 for the surgery and a 59 for the procedure.

I have always used just modifier 57 for this scenario and never had a problem but someone working with me is thinking we need both.

Please shed some light on this question and explain why.

Thank you!

 

[twizzle]

Question was brought up and we need clarification on these modifiers.

When a surgery AND a procedure are both done on the DOS or day before we would only need to append the modifier 57 to the E/M or H&P......or, do we nee dthe 57 for the surgery and a 59 for the procedure.

I have always used just modifier 57 for this scenario and never had a problem but someone working with me is thinking we need both.

Please shed some light on this question and explain why.

Thank you!

if a procedure is done the same day(separately identifiable from the E&M) and the decision for surgery is made(same day or following day) you would bill your E&M with 25 and 57.

 

[Monika Liddle]

Modifier 57 is for procedures with a global period of 90 days and is used for EM on the same day or day before the decision for surgery is made.

Modifier 25 is used for procedures with a 0 or 10 day global period and used for EM on the same day the procedure is performed, which needs to be separately identifiable from the procedure.