tci Part B Insider - 2009 Issue 3

Part B Mythbuster: Modifier 57 Alone Should Preclude the Need for 25

Medicare carriers don't require you to append both modifiers. Myth: Payers "don't like" modifier 57 (Decision for surgery), so it's okay to use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) instead. Reality: You should append modifier 57 to an E/M service that occurs on the same day, or on the day before, a major surgical procedure, and which results in the physician's decision to perform the surgery. Scenario: Suppose your physician performs an E/M service followed by three major procedures. You erroneously append...

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