57 vs 25

solocoder

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Springfield, Mo
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In our office we have been adding -25 to our e/m codes when also billing fx care codes for closed treatment done in the office. Lately I have read that -57 is correct because of the 90 global for those codes. Then I read that it depends on the payer. :confused: Unfortunately, I don't know what payers want. Any advice is appreciated.
 
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jmcpolin

True Blue
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modifier 57 is typically for a decision made at the time of visit for a 90 day global period and 25 is usually for 10 day global or less.
 

ajs

True Blue
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Tacoma, WA
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In our office we have been adding -25 to our e/m codes when also billing fx care codes for closed treatment done in the office. Lately I have read that -57 is correct because of the 90 global for those codes. Then I read that it depends on the payer. :confused: Unfortunately, I don't know what payers want. Any advice is appreciated.
It may be a case of trial and error. In general, if it is a procedure that can be done in the office, even if it has a 90 day global, I would use the 25 modifier. If after using the 25 your office visit claim is denied, then rebill using the 57 modifier.
 

kathy a

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I have billed fracture codes for an orthopaedic surgeon for almost three years now and have always used the 25 modifier with no problems in the office. I use the 57 modifier for the hospital. Kathy Albert
 
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