Wiki Use of Modifier 57 - Decision to Perform Surgery

carlystur

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I've been coding initial and subsequent hospital visits, which I still am pretty new at, and we have a patient who originally had gotten the decision to perform surgery was two days before it happened. I would think that the claim shouldn't have modifier 57 on it since the surgery didn't happen the same day or the previous day, but I wanted to see what others said first.
 
I've been coding initial and subsequent hospital visits, which I still am pretty new at, and we have a patient who originally had gotten the decision to perform surgery was two days before it happened. I would think that the claim shouldn't have modifier 57 on it since the surgery didn't happen the same day or the previous day, but I wanted to see what others said first.
The modifier 57 would have been added for the visit when the actually decided to have the surgery, regardless of how many days later they actually had the surgery.
 
Carly, you are correct. Modifier 57 is only appended the day of or the day before a major procedure. You don't append it just because they made a decision to perform surgery unless the surgery is the next day or same day. In your example two days before, it doesn't get a 57.

 
Carly, you are correct. Modifier 57 is only appended the day of or the day before a major procedure. You don't append it just because they made a decision to perform surgery unless the surgery is the next day or same day. In your example two days before, it doesn't get a 57.

Thank you! That's what I thought, but there's another coder here that told me to add it whenever the decision for surgery was made regardless of the fact that the guidelines for that modifier state otherwise.
 
Thank you! That's what I thought, but there's another coder here that told me to add it whenever the decision for surgery was made regardless of the fact that the guidelines for that modifier state otherwise.
Nope, but it's a common confusion especially for newer folks. A good way to help explain is the fact that it's a "money modifier", you need it to tell the payer, "Hey payer, pay this because it is separate and distinct from the global I am performing today or tomorrow." The payer would have paid an E/M that wasn't the day before or day of because it doesn't hit against the major procedure, provided all the other coding was correct ;)
 
Nope, but it's a common confusion especially for newer folks. A good way to help explain is the fact that it's a "money modifier", you need it to tell the payer, "Hey payer, pay this because it is separate and distinct from the global I am performing today or tomorrow." The payer would have paid an E/M that wasn't the day before or day of because it doesn't hit against the major procedure, provided all the other coding was correct ;)
Thank you for the explanation! That makes sense. (y)
 
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