Author Topic: Will modifier -57 (decision for surgery same day as E&M) reduce E&M allowed $$  (Read 2115 times)


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a patient had his 2nd visit to our physician's office.  on the 2nd visit, the doctor performed closed fracture care.  i'm thinking i should bill it this way: 99214-57 and 25600.

i'm wondering 1) will the -57 get both codes paid?  2) will using -57 reduce the payable amount of 99214 (compared to if only 99214 was billed that day?)   

 ??? ???


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If the 2nd visit was an E&M visit where the dr made the decision to perform the closed fracture repair (surgery) then the 57 modifier would be accurate.  Insurance carriers have their own guidelines on how they will process the claim, so there is no guarantee both codes will be allowed.

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