AMA CPT® Assistant - 2003 Issue 5 (May)
Use of Modifiers -25 and -57 (May 2003)
May 2003 pages 17-18 Coding Update:Use of Modifiers -25 and -57 Some of the most commonly asked questions about coding involve the use of modifiers '-25' and '-57.' Although it may seem like we've written volumes about it, there is clearly still some confusion surrounding appropriate reporting methods. So let's take another look at modifier '-25' and '-57.' -25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: The physician may need to indicate that on the day a procedure or service identified by a...
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Article Overview
This CPT Assistant article explains the general purpose of modifiers -25 and -57 and discusses why they are frequently confused in outpatient and procedural coding. It is intended for coders, billers, physicians, and compliance staff who need to understand the broader context for reporting evaluation and management services alongside procedures or surgery-related visits. The article uses narrative guidance and examples to illustrate how the modifiers relate to same-day services, preoperative and postoperative care, and the decision for surgery.
Why This Topic Matters
Correct modifier reporting affects claim accuracy, documentation interpretation, and how encounters are represented for reimbursement and records management. This article helps readers distinguish between broadly similar billing scenarios involving evaluation and management services and procedural care.
Article Sections
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Coding Update
Introduces the topic and frames the discussion as a review of commonly questioned modifier use in CPT-based coding.
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Appropriate Use of Modifier -25
Discusses modifier -25 in the context of evaluation and management services provided on the same date as another service or procedure. Includes narrative examples involving office visits and procedural encounters.
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Appropriate Use of Modifier -57
Discusses modifier -57 in relation to evaluation and management services associated with the decision to perform surgery. Summarizes the modifier in the context of CPT surgical package concepts and a brief example.
What You Will Learn
- The general purpose of modifier -25 within CPT coding
- The general purpose of modifier -57 within CPT coding
- How the article contrasts same-day evaluation and management services with surgery-related decision visits
- How CPT surgical package concepts are discussed in relation to these modifiers
Who Should Read This
- Medical coders
- Billing staff
- Physicians
- Compliance staff
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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