Forum - Questions & Answers

Aug 21st, 2010 - cgloomis 1 

Use of modifiers 25 and 57

Please send documentation on the correct use of these modifiers. My office manager insists that I use both of these with the e&m code for a 0-10 day global procedure!

what would you do?

Aug 21st, 2010 - nmaguire   2,606 

25/57

Medicare makes it very clear that modifier -25 is used when a MINOR procedure is performed at same time as an E/M.
Modifier -57 is used when in the global period of major surgery (90) days and the decision for the major procedure was made the day before or the day of the major surgical procedure.

Aug 24th, 2010 - Codapedia Editor 1,399 

modifiers 25 or 57

Codapedia has many articles in the data base, as well as the Q&A forum.

You can search for these articles in the search box above "Look it up."

here are a few:

http://codapedia.com/-article_206_.cfm

http://codapedia.com/-article_260_.cfm

http://codapedia.com/-article_483_.cfm

Aug 28th, 2010 - cgloomis 1 

Mod 57

Thank you so much for your response! I know the criteria that needs to be met in order to use mod 57. I very much appreciate providing database articles that pertain to proper usage of this modifier.

the issue is that I am instructed to put modifier 57 along with any office CPT that requires mod 25!

i feel that it seems moronic that I must use this modifier that very well can indicate when the decision for a major surgery is made to be used with office procedure ie; anoscope but it is true...

are there articles in any database that indicate mod 57 is allowed to be used with any (0-10 fud) CPT? I am told there are articles but am unable to locate them!

my employment has been threatened if I do not accept this protocol.

Aug 30th, 2010 - Codapedia Editor 1,399 

modifier 25 and 57

There are no articles stating you can't use both.

Sorry we can't help, but there are rarely citations to prove a negative.

Sep 1st, 2010 -

Doesn't this say what you need?

Modifier -57 It is only used on procedures with a 90 day global period, per CMS, although this is not a CPT® rule. It is only used the day of or before a major surgical procedure. (For a minor surgical procedure, with 0 or 10 global days, no modifier is needed the day before the service, and a 25 modifier is needed the day of the service, if the E/M service was a distinct, separate procedure.)

Clearly an anoscopy at the time of a visit for rectal bleeding requires a 25 and not a 57.



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