Failure to use modifier -57 could decrease your pay

Why This Topic Matters

The article addresses a common reimbursement issue: whether an E/M service is separately payable or bundled into a procedure claim. Understanding the topic can help readers identify when a modifier may be needed in broad same-day visit and surgery situations.

Article Sections

1. Same-day E/M visit and fracture treatment example

   An opening example presents a same-day office visit and procedure scenario and frames the payment issue that follows. It introduces the concept of a surgical global period in relation to the encounter.

2. General guidance on modifier -57

   This section explains the purpose of the modifier in relation to the decision for surgery and discusses how it relates to E/M reporting. It also references broader CPT surgical package language and coding policy context.

3. Tips for payer use and Medicare distinction from modifier -25

   This section outlines payer-type considerations and contrasts different same-day reporting situations involving minor procedures and procedures with a longer global period. It focuses on general billing distinctions rather than specific code selection.

4. Hospital visit twist

   The closing example describes a hospital-based scenario involving consultation and subsequent visits before surgery can proceed. It shows how the discussion extends to inpatient-type encounter reporting.