Initial Evaluation

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March 17, 2016

Question:
Can a surgeon always be paid for an initial evaluation before a major surgery, or is that included as part of the global package?

Answer:
A surgeon may always be paid for an initial evaluation before a surgery with 90 global days. If that visit takes place the day or the day before a major surgical procedure, append modifier -57 to the evaluation and management service. It’s true that every surgical procedure includes payment for pre-operative, intraoperative and post-operative work, but wherever the first evaluation takes place—in the office, the Emergency Department or the hospital, the surgeon should be paid. Modifier -57 is only required if it is the visit at which the decision for surgery was made and the surgery takes place that day or the next day.

*This response is based on the best information available as of 03/17/16.