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Thread: Modifier 57 vs Modifier 25

  1. #1

    Talking Modifier 57 vs Modifier 25

    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. #2

    Default

    If the surgery was the same day you would use the 25

  3. #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
    Join Date
    Apr 2007
    Location
    Santa Rosa
    Posts
    3

    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
    Join Date
    Apr 2007
    Location
    Phoenix, AZ
    Posts
    621

    Default

    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
    Join Date
    Apr 2007
    Location
    Seacoast- Dover New Hampshire
    Posts
    604

    Default

    Why aren't you using the observation codes in the observation setting?
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  7. #7

    Default

    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
    Join Date
    Apr 2007
    Posts
    12

    Default

    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
    Join Date
    Apr 2007
    Location
    Greater Pittsburgh Chapter
    Posts
    20

    Default

    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. #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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