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Thread: Correct Use Of Modifier 57

  1. #1

    Default Correct Use Of Modifier 57

    Hello,

    Can someone please clarify for me the correct use of modifier 57, please?

    To my understanding, this modifer is only to be used for surgeries that have a 90 day global period attached--am I correct?

    Can someone please refer me to a printed source that shows the correct use of this code?

    One of my providers is questioning the use of this code. He thinks that it can be used if a patient comes into the office for skin tag removal or a laceration repair and I need some sort of reference to take back to him.

    Can someone please give me an example of when 57 would be appended?

    Thanks.
    Last edited by dballard2004; 04-06-2009 at 03:29 PM.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Coder

  2. #2
    Join Date
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    North Carolina
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    Default

    http://www.cms.hhs.gov/transmittals/...ads/R954CP.pdf

    Last page

    You're correct. If the office is a separate, identifiable service, modifier 25 would apply.
    Last edited by RebeccaWoodward*; 03-30-2009 at 09:48 AM.

  3. #3
    Join Date
    Apr 2007
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    22

    Default

    You would use 25 for an office visit with a procedure done on the same day and 57 on an E/M same day or day before for Medicare patients with a procedure done with a 90 day global.

  4. #4
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    Apr 2007
    Location
    Central Mississippi
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    Default

    An excellent explanation can be found at :
    http://nyssmoh.blogspot.com/2008/12/...25-and-57.html.

  5. #5

    Default

    Good article. Thanks for sharing!

  6. #6

    Default

    I agree. Great article! Thanks so much for posting!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Coder

  7. #7

    Default one more question on modifier 57

    I would like to ask one more question regarding modifier 57 and E/M codes. Every where I looked and everything I have read said to apply to appropriate E/M codes. I understand how they are used, what I need to know is can a modifier 57 be used on a subsequent hospital code?
    I have a surgeon who performed a surgery, three days later the patient had to return to the OR for exploration which is a 90 day global. The surgeon saw this patient earlier and decided to take the patient back into the OR, but all I have is the subsquent hospital visit. I want to bill for this service. I previously billed 99232 with modifiers 25 and 24 thinking that I was unable to bill with a 57. Can anyone tell me or show me the reference that addresses this, as the term appropriate is actually very vague?

  8. #8

    Default Subsequent Visit Modifer 57

    If the patient has to return to surgery due to a complication of the original surgery the subsequent visit would be considered part of the global and the surgery would be billed with a 78 modifier. If the reason for surgery is not related to the original surgery you would bill the sub visit with a 24 and 57 modifier and bill the surgery a modifier 59. Here is a good link that explains the usage of modifiers.

    http://www.wpsmedicare.com/part_b/re...lsurgery.shtml

  9. #9

    Wink thanks for that link!

    thanks

  10. #10

    Default

    Hi,

    I agree with what you have explained for modifier 25 & 57 but I have a clarification if both a minor surgery and major surgery performed in the same visit, can we use both modifiers 25 & 57?

    For example, an ED physician did an intermediate laceration repair (minor procedure) and a fracture reduction (major), will you code E&M level with modifier 25 & 57?

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