tci Part B Insider - 2003 Issue 34

Modifiers: Bill Separately for Decision to Operate

Understand the difference between modifiers -57 and -25Before she picks up a scalpel, the surgeon needs to decide to operate on the patient. And this decision deserves its own reimbursement, even if it happens during the day before a surgery preceded by a one-day global period.  But what confuses many coders is which modifier to use for that service:  modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) or modifier -57 (Decision for surgery)? It depends on the circumstances, coding experts say.  When...

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