B. Consultation Followed by Treatment
A physician or qualified NPP consultant may initiate diagnostic services and treatment at the initial consultation service or subsequent visit. Ongoing management, following the initial consultation service by the consultant physician, shall not be reported with consultation service codes. These services shall be reported as subsequent visits for the appropriate place of service and level of service. Payment for a consultation service shall be made regardless of treatment initiation unless a transfer of care occurs.
Modifier 57: Decision for Surgery
An E/M examination coded with modifier 57 indicates a visit that resulted in the initial decision to perform a major surgery. It is used the day before or the day of major surgery. Surgeries that have a 90-day follow-up period are considered major surgeries. When coding modifier 57, ensure that the patient’s records clearly indicate when the initial decision to perform the surgery was made. Do not use modifier 57 with an E/M service performed on the same day as minor surgery
Modifier 25 would be attached to the E/M when performing a minor procedure (assuming they are provided on the same day).
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