Wiki Modifier 57 vs Modifier 25

[nancy.anselmo@ccrheart.com]

I am still confussed about when to use modifier 57. Pt presented to hospital. Dr did a consult on him as he had unstable angina and CAD. During this encounter the decision was made to do a LHC. Do I use the 25 or the 57 on the 99214 pt was in observation. Thanks Nancy

 

[abbyfraise]

If the surgery was the same day you would use the 25

 

[banderson77]

depends on the post op period for the procedure. If the procedure has a 90 day global period then the office visit/consult gets a 57. All other produres (10 day or less global period) the office visit gets a 25.

 

[mad49erdog]

mod 57 use w/major surgery decision

An E&M service provided the day before or the day of a major surgery that resulted in the initial decision to perform surgery is eligible for reimbursement if modifier -57 is appended to the E&M code.

 

[Cyndi113]

It is definitely dependent on the post op days (minor vs major). However, there is no post op period for a heart cath. So in answer to your question, use a -25.

 

[kbarron]

Why aren't you using the observation codes in the observation setting?

 

[Mojo]

Why aren't you using the observation codes in the observation setting?

Since the OP's physician was a consulting provider, it appears he did not initiate the observation status and he would use office or other outpatient codes.

 

[tlspeer]

I really found the information useful. I did not know that global period had anything to do with whether a modifier-25 or -57 was used.

 

[RILEY1959]

Its a good idea to check with your payor as well. LHC's are considered diagnostic where we are and are not a surgical code so we use mod 25 on the E/M.

 

[hayleeh]

Mod 25 or 57 for er e/m codes

I have a plastic surgeon/er doc who uses e/m codes 99281-99285, he does his own coding and we audit. We're all confused which modifier to use? 25 or 57? For ex a pt came to an er with a 1.3 cm laceration of the right nostril, so the doc coded 99284 57 for the visit and 12051 for the repair. Do I change the mod 57 to 25 since it's just stitches and not a surgery? Does mod 25 need two diagnosis codes? Help!

diagnosis codes, diagnosis coding

 

[mitchellde]

you would use the 25 due to the global days being 10 or less and no you do not need more than one dx code, look in appendix A of the AMA version of the CPT book to read the complete descriptor of the 25 modifier, in that you will see where it states "separate diagnoses are not required"...

diagnosis codes, diagnosis coding

 

[anastasia213]

Do you know where I can find "official" documentation regarding the global days effecting the use of 57 vs 25?

diagnosis codes, diagnosis coding

 

[mhstrauss]

Here is a link to our Medicare carrier's modifier flowcharts:

http://www.pinnaclemedicare.com/provider/partb/education/dataanalysis/modflow/default.aspx

There is a chart for 57, but not 25, even though it references 25 in 57...go figure LOL but it may help with the documentation you're looking for.

diagnosis codes, diagnosis coding