If you think of modifier 57 as the “decision for surgery” modifier, it’s time to change your mind Modifier 57 decision for surgery Learn when and how to use modifier 57 in medical coding
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Understand its role in e/m services and surgery claims with simple examples and coding tips.
Let’s simplify this modifier so you can receive separate payments for consultations that result in significant decisions.
Modifier 57 should be appended to any e/m service on the day of or the day before said procedure when the e/m service results in the decision to go to surgery This informs the payer that the physician determined the surgery was medically necessary. Modifier 57 is primarily used when a healthcare provider performs an evaluation and management (e/m) service (office visit, consultation, or other) on the same day as a major surgical procedure or on the day before the surgery. Modifier 57 applies to services when the physician provides the evaluation and management service that ensued in the initial decision to perform the surgery by adding modifier 57 to the appropriate level of e/m visit
The official description of the 57 modifier is “decision for surgery.” modifier 57 and modifier 25 may use for similar purposes. Documentation in the patient's medical record must support the use of this modifier This modifier should not be submitted with e/m codes that are explicitly for new patients only
New patient codes are automatically excluded from the global surgery package
This means that they are reimbursed separately from surgical procedures.
