MOD 57

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soujanya
Posts: 4
Joined: Fri Jan 12, 2018 2:55 pm

Thu Jun 21, 2018 6:11 pm

Can we append modifier 57 to initial evaluation of problem where physician takes a decision to perform surgery and that was a couple of weeks prior to day of surgery.
for example patient was initially evaluated on DOS 4/11/2018 & physician makes a decision to perform surgery. A couple of weeks later patient had a surgery performed by same physician on 6/12/2018.
Would it be E & M with mod 57 on DOS 4/11/2018, please clarify ?
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admin
Site Admin
Posts: 448
Joined: Mon Apr 09, 2012 1:54 pm

Mon Jun 25, 2018 10:55 am

Hello,

The modifier -57 is only used for an E&M service within the global period of a 90-day surgical procedure. In other words, if the decision is made the day before or the day of the 90-day global procedure, the -57 is used.

In the case below, the initial decision for surgery is made on 4/11, and the procedure is 60 days later. Not only is the -57 not used for the 4/11 service, but any E&M service the day before or the day of cannot use the -57 modifier, as it would not represent the initial decision for surgery.

Your question has been answered by J. Paul Spencer, CPC, COC
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