Medical Billing Forum
Coding => Coding => : sequelian August 30, 2011, 05:08:13 AM
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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
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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).
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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.
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@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.
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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
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I found that website through the AAPC forum.
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"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!
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Thank you all!!!!!