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Modifier 57 Alone Should Preclude the Need for 25

Posted on 04. Feb, 2009 by in Hot Coding Topics

Medicare carriers don’t require you to append both modifiers.

Myth: Payers “don’t like” modifier 57 (Decision for surgery), so it’s okay to use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) instead.

Reality: You should append modifier 57 to an E/M service that occurs on the same day, or on the day before, a major surgical procedure, and which results in the physician’s decision to perform the surgery.Don’t miss Barbara Cobuzzi’s modifier training session just for otolaryngology coders.

Scenario: Suppose your physician performs an E/M service followed by three major procedures. You erroneously append modifiers 25 and 57 to the E/M code.

Correct coding: Medicare payers should accept the claim with modifier 57 appended to the E/M code if the documentation supports it. You shouldn’t have to append...

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