Modifier 57 Fact Sheet
What You Need To Know
Modifier 57 is used to indicate an Evaluation and Management (E/M) service resulted in the initial decision to perform surgery either the day before a major surgery (90 day global) or the day of a major surgery.
Appropriate Uses
Append, only to the E/M procedure code, where the decision to perform surgery is made the day of or day before a major surgery during an E/M service.
Inappropriate Uses
Appending to a surgical procedure code.
Appending to an E/M procedure code performed the same day as a minor surgery.
When the decision to perform a minor procedure is done immediately before the service, it is considered a routine preoperative service and not billable in addition to the procedure.
Do not report on the day of surgery for a preplanned or prescheduled surgery.
Do not report on the day of surgery if the surgical procedure indicates performance in multiple sessions or stages.
Facts
Global period includes:
Day before surgery
Day of the surgery; and
Number of days following the surgery
Note: A major surgery has a 90 day post-operative period and a minor surgery has either a zero or a 10 day post-operative period.
Preoperative period is the day before the surgery or the day of surgery
E/M service resulting in initial decision to perform major surgery is furnished during post-operative period of another unrelated procedure, then the E/M service must be billed with both the 24 and 57 modifiers.
www.novitas-solutions.com
CCO Community thread on Modifiers:
CPT Modifiers
