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Wiki Modifier 57

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TenaWright

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Looking for advice because I am getting conflicting information. I have recently been told that 57 is only used for an E/M the day before or day of major surgery. I have been adding modifier 57 to office visits where the decision for major surgery is made - up to 30 days prior to scheduled procedures.

Is it appropriate to use modifier 57 to identify the decision for major surgery for a scheduled procedure?

From the Global Surgery book through CMS, it appears that modifier 57 should be used at any visit where the decision for major surgery is being made - regardless of time frame.
 
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A visit more than 1 day prior to the surgery (where the decision for surgery is made) is not within the global period, therefore -57 is not required to indicate the services were not part of the global package. I see where you are interpreting in the middle of page 6 regarding -57. However, when the visit is not within the global surgery period, it would simply not apply.
Here are some MAC's references for -57 which may make it clearer for you. They all state it's only appropriate when it's the day before or the day of a major surgery.

Modifier 57 Fact Sheet

www.novitas-solutions.com www.novitas-solutions.com

It is very possible you will still receive appropriate payment using -57 in your situation, but it is not the "most correct" coding. It would be the same as using -24 when the patient is 122 days post-op. It is not appropriate, but you'll probably still receive payment. We should strive for the most correct coding.
 
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Can we just bill modifier 57 with ENM code only if procedure having 90 days global period ? What other documentation needed apart from 90 days global period in progress notes to bill modifier 57 ?
 
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