Using Modifier 57

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May 26, 2016

Question:
I saw a patient on a Friday and scheduled surgery for that Monday. Do I need a 57 modifier on the E/M I did on Friday?

Answer:
No. The 57 modifier is required on an E/M code that is the decision for surgery visit if it occurs the day of or the day before the surgery.  It is this time period in which an E/M is bundled with a major procedure (one which has a 90 day global period).  The day before and the day of a major procedure, an E/M is included in the per-operative portion of the global package unless it is the visit in which the decision for surgery is made.

*This response is based on the best information available as of 05/26/16.