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Use of the Modifier 57

  1. #1
    Location
    Nassau, The Bahamas
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    Default Use of the Modifier 57
    Medical Coding Books
    I am having a debate with my supervisor regarding the proper use of the modifier 57. She states that this could only be used if the procedure is being performed on the day of the office visit or the following day. Could someone please give some clarification as I don't understand it to be that way!

    Thanks- waiting patiently in the Bahamas
    Devon Melba K. Forbes, CPC

  2. Default
    Hi Devon,

    Yes Modifier 57 can be used even if the procedure is performed on the following day.

  3. #3
    Location
    Columbia, MO
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    Default
    The real key to "do I use a 57 or 25?" is the post op global days, and whether the procedure is performed on the same day as the evaluation to decide to perform the procedure.
    25 is used when the procedure is performed the same day as the E&M and has 10 days or less in the post op global.
    57 is used when the procedure is performed on the same day as the evaluation AND there are more than 10 days in the post operative global, or the procedure is planned for within the next few days after the evaluation
    Last edited by mitchellde; 09-06-2010 at 09:45 AM.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Default
    As Mitchellde pointed out...

    Modifier 57 is used on the E/M code for the office visit wherein the decision is made for major surgery (90 day global period) to take place on the same day or the following day.

    For minor surgery (10 day global period) decided for the same day or following day, modifier 25 is appended to the E/M office visit.

  5. #5
    Location
    Nassau, The Bahamas
    Posts
    13
    Smile
    Thanks so much guys but the confusion sets in when the procedure is not being performed on the same day or the following dat. Could the modifier 57 still be used if the procedure is not being performed for another week, four weeks, six months, etc....?
    Devon Melba K. Forbes, CPC

  6. #6
    Location
    Columbia, MO
    Posts
    12,531
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    Yes it can be, the clue is how many days are in the PRE op global for this question. Most of the time that is recognized as 1 day prior to the surgery, however I have had some payers recognise 7 days prior to the surgery as a preop timeframe. Also what is the likelihood that the surgery date could be moved up and now the surgery is within the preop time of the visit. The purpose of the 57 modifier is to signal to the payer that the visit should be paid as not peing a preop encounter but rather the visit not part of the surgical event where the decision was made after evaluation to perform the surgery.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    Nassau, The Bahamas
    Posts
    13
    Smile
    Thanks so much, this helps tons!!!!!!!!!!!!!!!!! For this particular case it was an evacuation of uterus that occured the same day. I learned in class that once a decision for surgery was the result of an office visit, we should append a modifier 57 onto that E/M code. The pre op office visit would then be covered under the global surgical package. I know some surgeries such as the lap band system have a waiting period between the intial decision for surgery and the procedure itself; so in this case the modifier should be appended although the procedure does not occur for possibly three months later.

    I just needed to verify this as she advised me to research online as how to properly use the modifier. Thank you sooo much for all of the input, I greatly, greatly appreciate it!!!!
    Devon Melba K. Forbes, CPC

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