tci ED Coding & Reimbursement Alert - 2009 Issue 2

Reader Questions: Global Period Drives Choice Between 25, 57

Question: I have never really understood what separated modifiers 25 and 57. Could you explain the difference between them, and when I should use each? Connecticut Subscriber Answer: Look at the procedure's global days to determine whether you must append either modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) or 57 (Decision for surgery) to the E/M code. Use modifier 25 when - the ED physician provides an E/M, and then performs a minor procedure (meaning one with a 0- to 10-day global period)...

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