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57 vs 25

  1. #1
    Location
    Springfield, Mo
    Posts
    382
    Default 57 vs 25
    Medical Coding Books
    In our office we have been adding -25 to our e/m codes when also billing fx care codes for closed treatment done in the office. Lately I have read that -57 is correct because of the 90 global for those codes. Then I read that it depends on the payer. Unfortunately, I don't know what payers want. Any advice is appreciated.
    Last edited by solocoder; 01-16-2012 at 02:17 PM.
    solocoder CPC

  2. #2
    Location
    Salt Lake City
    Posts
    841
    Default
    modifier 57 is typically for a decision made at the time of visit for a 90 day global period and 25 is usually for 10 day global or less.
    Jenifer McPolin CPC, CPMA, RCC

  3. #3
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by solocoder View Post
    In our office we have been adding -25 to our e/m codes when also billing fx care codes for closed treatment done in the office. Lately I have read that -57 is correct because of the 90 global for those codes. Then I read that it depends on the payer. Unfortunately, I don't know what payers want. Any advice is appreciated.
    It may be a case of trial and error. In general, if it is a procedure that can be done in the office, even if it has a 90 day global, I would use the 25 modifier. If after using the 25 your office visit claim is denied, then rebill using the 57 modifier.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  4. #4
    Location
    Springfield, Mo
    Posts
    382
    Default
    Thanks for the advice!
    solocoder CPC

  5. Smile
    I have billed fracture codes for an orthopaedic surgeon for almost three years now and have always used the 25 modifier with no problems in the office. I use the 57 modifier for the hospital. Kathy Albert

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