Wiki Modifier 57


Phoenix, AZ
Best answers
Can modifier 57 be used on an exam by a physician within the same practice if he did not perform the surgery? First Dr performed the exam and referred to a surgeon within the same practice who did surgery the same day. The surgeon did not bill an exam. Thanks
Who made the decision that the patient needed surgery and advised patient on benifits, risks and alternatives and patient agreed.
The office notes for Dr #1 states "refer to retina dr for laser prophylaxis today." The notes for Dr #2 shows that he obtained consent and performed the laser.
Same specialty & same practice

Two physicians of the same specialty in the same practice are - for billing purposes - considered the same physician.

I would use a -57 modifier on the office visit if that is when the decision was made that surgery is required.

We have this happen with our surgeons - Surgeon A sees a patient in clinic and determines patient needs surgery; on-call surgeon B is able to fit patient in today. We put a -57 on Surgeon A's office visit charge.

Hope that helps.

F Tessa Bartels, CPC, CEMC