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Modifier 57 vs Modifier 25

  1. Talking Modifier 57 vs Modifier 25
    Medical Coding Books
    I am still confussed about when to use modifier 57. Pt presented to hospital. Dr did a consult on him as he had unstable angina and CAD. During this encounter the decision was made to do a LHC. Do I use the 25 or the 57 on the 99214 pt was in observation. Thanks Nancy

  2. Default
    If the surgery was the same day you would use the 25

  3. Default
    depends on the post op period for the procedure. If the procedure has a 90 day global period then the office visit/consult gets a 57. All other produres (10 day or less global period) the office visit gets a 25.

  4. #4
    Default mod 57 use w/major surgery decision
    An E&M service provided the day before or the day of a major surgery that resulted in the initial decision to perform surgery is eligible for reimbursement if modifier -57 is appended to the E&M code.

  5. #5
    Phoenix, AZ
    It is definitely dependent on the post op days (minor vs major). However, there is no post op period for a heart cath. So in answer to your question, use a -25.

    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  6. #6
    Seacoast- Dover New Hampshire
    Why aren't you using the observation codes in the observation setting?
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  7. #7
    Quote Originally Posted by kbarron View Post
    Why aren't you using the observation codes in the observation setting?
    Since the OP's physician was a consulting provider, it appears he did not initiate the observation status and he would use office or other outpatient codes.

  8. #8
    I really found the information useful. I did not know that global period had anything to do with whether a modifier-25 or -57 was used.

  9. #9
    Greater Pittsburgh Chapter
    Its a good idea to check with your payor as well. LHC's are considered diagnostic where we are and are not a surgical code so we use mod 25 on the E/M.

  10. Default Mod 25 or 57 for er e/m codes
    I have a plastic surgeon/er doc who uses e/m codes 99281-99285, he does his own coding and we audit. We're all confused which modifier to use? 25 or 57? For ex a pt came to an er with a 1.3 cm laceration of the right nostril, so the doc coded 99284 57 for the visit and 12051 for the repair. Do I change the mod 57 to 25 since it's just stitches and not a surgery? Does mod 25 need two diagnosis codes? Help!

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