Medical Billing Forum

Coding => Coding => Topic started by: sequelian on August 30, 2011, 02:08:13 AM

Title: Modifier 25 vs Modifier 57
Post by: sequelian on August 30, 2011, 02:08:13 AM
Hi,

Can someone tell that can v append modifier 25 and 57 together with E&M service if the major surgery procedure is performed in the same day...or we just need to append modifier 57 with E&M service instead of appending both?

Thanks

Todd
Title: Re: Modifier 25 vs Modifier 57
Post by: Michele on August 30, 2011, 07:40:59 AM
If you are only billing the E&M and the surgery, then only one of those modifiers would be needed (whichever one more accurately describes the situation).
Title: Re: Modifier 25 vs Modifier 57
Post by: asilva03 on August 30, 2011, 11:21:17 AM
Use modifier 25 when the surgery is minor, like requiring a 10- day global period or no global period at all.  Use modifier 57 when the surgery is major and requires a 90 global period.

Hope this helps.
Title: Re: Modifier 25 vs Modifier 57
Post by: DMK on August 30, 2011, 02:11:56 PM
@asilva you may be mis-interpreting those modifiers.  Check your definitions.  -25 is for a significant separately identifiable E&M on the same day as another procedure or service (not minor as opposed to major surgery),  -57 is for the E&M that resulted in the decision to do surgery AT ALL.
Title: Re: Modifier 25 vs Modifier 57
Post by: asilva03 on August 30, 2011, 09:31:27 PM
I have checked my definitions and yes modifier -25 is for a significant separately identifiable E&M on the same day as another procedure or service, but mainly is used on minor surgeries. 

Check out this website

http://nyssmoh.blogspot.com/2008/12/ngs-news-modifier-25-and-57.html
Title: Re: Modifier 25 vs Modifier 57
Post by: asilva03 on August 30, 2011, 09:33:57 PM
I found that website through the AAPC forum.
Title: Re: Modifier 25 vs Modifier 57
Post by: DMK on August 31, 2011, 10:54:31 AM
"Modifier 57 indicates the E/M service resulted in the decision to perform major surgery"

(From your site)

That's awesome verbage!  My CPT book's definition was shorter than that.  I added that extra verbage in writing to mine.  That really helps to further define a code and definition.  Thanks for the clarification!
Title: Re: Modifier 25 vs Modifier 57
Post by: sequelian on September 06, 2011, 12:27:15 AM
Thank you all!!!!!