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 or the day of a major surgery (90-day global).
Appropriate usage
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 usage
- Appending to a surgical procedure code.
- Appending to an E/M procedure code performed the same day as a minor surgery.
- Note: 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.
- Note: 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.
- 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.
For more information, please visit in our website:
Reference