I have been using modifier 57 with E/M when decision for surgery has been made, this could be between 2weeks before the surgery to 1 day before the surgery. A co-worker went to a meeting and they told her to only use modifier 57 when the office visit is within 24 hrs of surgery. Which is correct. Thanks for your help. Margie
Thank you for your email. Modifiers tend to be one area in coding for some reason where there are so many misapplications. The Modifier 57 as you know is the initial decision for surgery. The guidelines to employ when using this modifier are as follow:
Modifier 57 is to be used when the initial decision is made to perform a major surgery (one that carries 90 global days). The decision must be the day of, or the day before the major surgery Modifier 57 should not be used with surgeries that carry either 0 or 10 global days No additional documentation is necessary for claim submission
A 14 year-old boy presents to the general surgeons office with complaints of severe LLQ abdominal pain. A comprehensive exam and high complexity decision making result in a decision for this patient to be taken to the OR right away.