tci Part B Insider - 2010 Issue 19

Reader Questions: Choose 25 or 57 With These Guidelines

Question: I'm confused about the distinction between modifiers 25 and 57. Could you please explain the difference?Answer: You might use 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 modifier 57 (Decision for surgery) when your surgeon performs a procedure and a distinct E/M service for the same patient on the same day. The quickest distinction is that you would use 25 for a distinct E/M with a minor procedure, and 57 for a distinct E/M with a major follow-up procedure. Read...

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