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Thread: Modifier -57 clarification

  1. #1

    Default Modifier -57 clarification

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007
    Greeley, Colorado

    Thumbs up

    I agree with Donna.
    Lisa Bledsoe, CPC, CPMA

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