Mind your modifiers: Append 57 only to decision for major surgery E/M

Why This Topic Matters

Incorrect modifier use around surgery can affect payment, compliance, and audit risk. The article helps readers recognize where documentation and timing issues may trigger denials or overpayment concerns.

Article Sections

1. Overview of modifier 57 and global period concerns

   Introduces the compliance and reimbursement issue involving E/M services around surgery and cites the OIG and Medicare/CPT context.

2. Correct and incorrect use examples

   Uses contrasting clinical scenarios to illustrate the general distinction between initial surgical decision-making visits and later preoperative visits.

3. Medicare and CPT policy guidance

   Summarizes policy language and official guidance related to preoperative services within the global surgical package.

4. Additional fracture care example

   Addresses an additional scenario involving fracture treatment and surgery-related E/M billing considerations.

5. Fee schedule and official resources

   Provides a brief reimbursement context example and lists reference materials from Medicare and CMS.