Modifier 57 fact sheet

What you need to know

Modifier 57 is used to indicate an evaluation and management (E/M) service resulted in the initial decision to perform surgery either the day before or the day of a major surgery (90-day global).

Appropriate usage

Append, only to the E/M procedure code, where the decision to perform surgery is made the day of or day before a major surgery during an E/M service.

Inappropriate usage

  • Appending to a surgical procedure code.
  • Appending to an E/M procedure code performed the same day as a minor surgery.
    • Note: When the decision to perform a minor procedure is done immediately before the service, it is considered a routine preoperative service and not billable in addition to the procedure.
  • Do not report on the day of surgery for a preplanned or prescheduled surgery.
  • Do not report on the day of surgery if the surgical procedure indicates performance in multiple sessions or stages.

Facts    

  • Global period includes:
  • Day before surgery
  • Day of the surgery; and
  • Number of days following the surgery
    • Note: A major surgery has a 90-day post-operative period, and a minor surgery has either a zero or a 10-day post-operative period.
  • Preoperative period is the day before the surgery or the day of surgery
  • E/M service resulting in initial decision to perform major surgery is furnished during post-operative period of another unrelated procedure, then the E/M service must be billed with both the 24 and 57 modifiers. 

For more information, please visit in our website: 

Modifier 57 Flowchart 

Global Surgery

 

Reference