57 vs 25

[solocoder]

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. Unfortunately, I don't know what payers want. Any advice is appreciated.

 

[jmcpolin]

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]

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. 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.

 

[solocoder]

Thanks for the advice!

 

[kathy a]

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