Wiki Modifier 57

[lindam@caricures.com]

When can I use Modifier 57. If a patient is being followed as an inpatient, and a decision was made for surgery, and they have surgery the next day, can I use modifier 57 on the day before. I feel like the day before is included in Global Period, so what is the purpose of Modifier 57? When should it be used?

 

[kamalpal]

To use the 57 modifier, its very simple only validate the visit notes, who did the decision of surgery. It may be append day before surgery if decision of surgery done or day of surgery.

For Example Dr A supervised his /her staff i.e NP OR AP on 08/05 at 10:30 AM in the ER room. And decision of surgery done at the same time. Then Same Dr A performed the surgery for patient on 08/05 at 3:30 PM. In this example we will append the 57 modifier with initial visit Like 99284-57. Hope it helps U..

 

[lindam@caricures.com]

To use the 57 modifier, its very simple only validate the visit notes, who did the decision of surgery. It may be append day before surgery if decision of surgery done or day of surgery.

For Example Dr A supervised his /her staff i.e NP OR AP on 08/05 at 10:30 AM in the ER room. And decision of surgery done at the same time. Then Same Dr A performed the surgery for patient on 08/05 at 3:30 PM. In this example we will append the 57 modifier with initial visit Like 99284-57. Hope it helps U..

Thank you. in my case the patient has been in the hospital for multiple days, followed by multiple specialties for Ulcerative colitis - Gastroenterology, internal medicine, and the provider I work for - Colon/rectal surgery. He has been seeing the patient daily, and it has been decided that he should have his colon removed. On 8/5/25 patient was seen and it was decided he should undergo the surgery, scheduled for the next day 8/6/25. If I understand the global period rules, I can't bill a visit on 8/5 as it is included in the global period for the surgery 8/6. So I am thinking, I won't use modifier 57 at all then. I hope my question makes sense

 

[kamalpal]

As per the case patient admitted with problem Ulcerative colitis, on 8/5/25 gastroenterologist decided for surgery for the patient. Now you have to validate in the 08/05 visit notes like " discussion with patient and consent should be there from the patient and any family members to proceed the surgery also provider marked the area site of surgery. If its there 57 modifier qualify with 08/05 visit.

If its not done yet and same Dr provider gastroenterologist reviewed the patient on 08/06 morning before the surgery. And placed the separate progress notes for reviewing the patient and did this task "discussion with patient and consent from the patient and any family members acceptance to proceed the surgery also marked the area site of surgery" Then 57 modifier will qualify for 08/06 DOS for same Provider not for 08/05.

And for better understanding the global period rules :

What services aren’t included in the global surgery payment?

We exclude these global surgical payment services. You may bill them separately and get paid:

● Surgeon’s first evaluation to find the need for major surgeries. Bill this separately using modifier–57 (Decision for Surgery). Only bill this separately for major surgical procedures. And your provider decided surgery is comes under major surgeries categories.

This will help U for better understanding.
Happy Coding

 

[lindam@caricures.com]

As per the case patient admitted with problem Ulcerative colitis, on 8/5/25 gastroenterologist decided for surgery for the patient. Now you have to validate in the 08/05 visit notes like " discussion with patient and consent should be there from the patient and any family members to proceed the surgery also provider marked the area site of surgery. If its there 57 modifier qualify with 08/05 visit.

If its not done yet and same Dr provider gastroenterologist reviewed the patient on 08/06 morning before the surgery. And placed the separate progress notes for reviewing the patient and did this task "discussion with patient and consent from the patient and any family members acceptance to proceed the surgery also marked the area site of surgery" Then 57 modifier will qualify for 08/06 DOS for same Provider not for 08/05.

And for better understanding the global period rules :

What services aren’t included in the global surgery payment?

We exclude these global surgical payment services. You may bill them separately and get paid:

● Surgeon’s first evaluation to find the need for major surgeries. Bill this separately using modifier–57 (Decision for Surgery). Only bill this separately for major surgical procedures. And your provider decided surgery is comes under major surgeries categories.

This will help U for better understanding.
Happy Coding

thank you