Decision for Surgery. An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service.
The payment for major surgery includes E/M services provided on the day of and the day before a major surgical procedure, unless it is the visit at which the decision for surgery was made.
- A major surgical procedure is a procedure with 90 global days.
- Only use modifier 57 on the visit for which surgery was made when the major surgery will be done that day or the next day.
- Use modifier 57 on the E/M service—office visit, ED visit, initial hospital service, critical care service or any E/M service.
- Allows physician to be paid for the initial evaluation that results in surgery that day or the day before the surgery.
- Use to indicate to payer that E/M service is a significant, separate service from other procedures performed on same day. This is typically the “urgent” decision for surgery modifier.
- A different diagnosis is not required.
To unlock the rest of this article, and hundreds of coding education resources in our on-line library, become a member!