hOW TO USE MODIFIER 57

Definition: Indicates 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. You can access this information on the Medicare Physicians Fee Schedule Data Base.

APPROPRIATE:

• Append where the decision to perform surgery is made the day of or day before a major surgery during an E/M service
• Append only to the E/M procedure code

INAPPROPRIATE:

• 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.

Below are information that you need to understand and remember; many are still confused with this:
Global period is the day before surgery, the day of the surgery and the number of days following the surgery as indicated on the MPFSDB. Often, 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.

A preoperative period is the day before the surgery or the day of surgery.

When an E/M service resulting in the initial decision to perform major surgery is furnished during the post-operative period of another, unrelated procedure, then the E/M service must be billed with both the 24 and 57 modifiers.

See Codes:
92002-92014    E/M Ophthalmology Services
99201-99499    E/M all locations