Coding Modifier 57 with E/M Visits

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June 9, 2016

Question:
If I see a patient and during an E/M visit where I identify the need for surgery the same day, can I append a Modifier 57 to the E/M service and get paid for that E/M service?

Answer:
Yes, if you determine during the evaluation that the patient requires surgery the same or next day for a major procedure (90 day global) and append Modifier 57 to the E/M service. This should allow payment for that “decision for surgery” E/M. However, that being said, we are seeing denials from various payers when reporting Modifier 57, particularly when the patient is evaluated in the emergency department. You may need to appeal any claim denials as CPT guidelines allow the use of Modifier 57.

*This response is based on the best information available as of 06/09/16.

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