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Policy No: 104

Originally Created: 11/01/2008

Section: Modifiers

Last Reviewed:  04/01/2019

Last Revised:  04/01/2018

Approved: 04/04/2019

Effective Date:  05/01/2019

This policy applies only to physicians and other qualified health care professionals.

Definition

Modifier 57

Current Procedural Terminology (CPT®) Modifier 57 a two position numeric code appended to an Evaluation and Management (E&M) code when provided on the day before or the day of a Major Procedure.

Major Procedure

Surgical procedures with a 1-day preoperative period and 90 day postoperative period.

Minor Procedure

Surgical procedures with a 0 or 10 day postoperative period.

Policy statement

An E&M service provided the day before or the day of a Major Procedure that resulted in the initial decision to perform surgery is eligible for reimbursement if modifier 57 is appended to the E&M code.

Modifier 57 should not be used when the E&M service is associated with a Minor Procedure.

Modifier 57 should not be used when the E&M service was for the preoperative evaluation (when the decision to perform surgery has already been made and the purpose of the exam is a "pre-op visit" to evaluate the current medical status of a patient before a scheduled surgical procedure).

The submission of modifier 57 appended to an E&M procedure code indicates that documentation is available in the patient's records confirming that the E&M service resulted in the initial decision to perform the surgery.

References

American Medical Association. "Appendix A: Modifiers" Current Procedural Terminology (CPT). AMA Press

National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services, current version Chapter 1

Cross References

Global Days

Disclaimer

Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.