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modifier 57 -medicare require

  1. #1
    Default modifier 57 -medicare require
    Exam Training Packages
    Does medicare require mod 57 on e/m day before surgery even if the surgery is minor in nature (I&D)? All help is appreciated.


  2. #2
    Red face
    The way we bill it is if the surgery is on the day before the E/M you would bill a 57 and if the surgery is on the same day of the minor surgery it would be mod 25 on the E/M for Medicare.

  3. #3
    Actually, on the Medicare website it states that if a surgery has a 10 day or less global, use mod 25, and 11-90 day global use 57.
    this is the link to a flowchart per the Medicare website.
    Last edited by arleneg65; 09-16-2011 at 02:42 PM. Reason: added additional information

  4. #4
    North Carolina
    Modifier 57 is for major surgeries.

    4. Evaluation and Management Service Resulting in the Initial Decision to Perform Surgery

    Evaluation and management services on the day before major surgery or on the day of major surgery that result in the initial decision to perform the surgery are not included in the global surgery payment for the major surgery and, therefore, may be billed and paid separately.

    In addition to the CPT evaluation and management code, modifier “-57” (decision for surgery) is used to identify a visit which results in the initial decision to perform surgery. (Modifier “-QI” was used for dates of service prior to January 1, 1994.)
    If evaluation and management services occur on the day of surgery, the physician bills using modifier “-57,” not “-25.” The “-57” modifier is not used with minor surgeries because the global period for minor surgeries does not include the day prior to the surgery. Moreover, where the decision to perform the minor procedure is typically done immediately before the service, it is considered a routine preoperative service and a visit or consultation is not billed in addition to the procedure.

    Page 96

  5. #5
    Thanks Ladies....

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