Results 1 to 3 of 3

Modifier -57 clarification

  1. Default Modifier -57 clarification
    Medical Coding Books
    Hi there! I know the basic rules of mod -57 are that you use it with an E/M when there is a decision made to perform a procedure with a 90-day global. However, we are trying to clarify if it can ONLY be used when the E/M is within 1 day of the procedure or if it can be used, for example, when an E/M is done a week prior to the procedure and they decide that the procedure has to be done. Please HELP!!! Thank you!

  2. #2
    Duluth, Minnesota
    you don't need the modifier on the E/M if the decision was made a week prior. It's to get the E/M service "out of the global" package. Because E/M services provided on the day of or day before the major procedure are considered included in the service for the surgery and not reimbursed separately. However, separate reimbursement can be made if the modifier .57 is appended to the E/M level to indicate that the initial decision to perform a major surgery was made during that visit on the day of day before the surgery.
    so, you see - you don't need it UNLESS the E/M is the day of or day before the surgery and RESULTED in the decision to do the major surgery.

    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  3. #3
    Greeley, Colorado
    Thumbs up
    I agree with Donna.
    Lisa Bledsoe, CPC, CPMA

Similar Threads

  1. Modifier 91 Clarification
    By celcano in forum Internal Medicine
    Replies: 1
    Last Post: 10-30-2014, 02:00 PM
  2. Modifier -26 clarification please
    By jademartinez in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 12-12-2013, 09:15 AM
  3. Modifier -77 Clarification
    By jsweeney23 in forum Modifiers
    Replies: 1
    Last Post: 11-23-2009, 09:38 AM
  4. Modifier -53 clarification
    By Nsteines in forum Modifiers
    Replies: 2
    Last Post: 06-16-2009, 01:03 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.